In reply
We appreciate the interest of Drs Gupta, Haboubi, and Thomas in "American Thyroid Association Guidelines for Detection of Thyroid Dysfunction," but we have reservations about extending the guidelines to recommend that all elderly adults be screened at the time of hospitalization. Their observation of a 16% prevalence of serum thyroid function test abnormalities in hospitalized elderly patients is quite similar to the larger published experience of Spencer et al,1 who reported abnormal serum TSH concentrations in 17% of 1580 hospitalized patients. However, only 55% of the patients with an elevated TSH concentration and only 24% of those with undetectable TSH actually proved to have thyroid disease, the remainder having transient thyroid function test abnormalities attributable to nonthyroidal illnesses or medications.