Albert L. Siu, MD, MSPH; Kirsten Bibbins-Domingo, PhD, MD, MAS; David C. Grossman, MD, MPH
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0483.
Siu AL, Bibbins-Domingo K, Grossman DC. Screening for Thyroid Dysfunction. Ann Intern Med. 2015;163:564-565. doi: 10.7326/L15-5141-2
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Published: Ann Intern Med. 2015;163(7):564-565.
Drs. Stern and Hennessey's comment seems to reflect a misunderstanding of our recommendation process, including the methods underlying our systematic evidence reviews. We welcome the opportunity to clarify these points. The U.S. Preventive Services Task Force makes recommendations that apply to average-risk persons without signs or symptoms of disease; "aggressive case-finding" falls outside the scope of our work. An "I statement" is not a recommendation against screening—it is an acknowledgment that the requisite evidence is lacking so that the balance of benefits and harms cannot be determined (1). The systematic evidence review used a standardized, validated approach to assess all included studies. Quality ratings (good, fair, or poor) apply to the internal validity of studies and include such factors as randomization or intention-to-treat analysis (2). Such issues as excluding symptomatic participants (a goal of the review) or enrolling participants after a single abnormal TSH measurement relate to external validity. The strength of evidence is based on an assessment of information from all studies.
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