Joel M. Schectman, MD, MPH; L. Gregory Pawlson, MD, MPH
Schectman JM, Pawlson LG. Screening for Thyroid Disease. Ann Intern Med. 1990;113:896-897. doi: 10.7326/0003-4819-113-11-896
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Published: Ann Intern Med. 1990;113(11):896-897.
To the Editors: In their recent article, Helfand and Crapo (1) state that total thyroxine (TT4) and sensitive-thyrotropin (TSH) assays have similar sensitivity and specificity in the diagnosis of hypothyroidism. This is open to question. If the normal reference range is used for each test, then the specificities of the tests will, of course, be similar. However, the sensitivity of the TT4 in detecting mildly symptomatic primary hypothyroidism (which would most likely be encountered in a screening or case-finding situation) would be much lower than that of the TSH assay. Two retrospective studies in primary care settings found that only
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