Glen L. Hortin, MD, PhD
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Hortin G.; Screening for Thyroid Disease. Ann Intern Med. 1999;130:161. doi: 10.7326/0003-4819-130-2-199901190-00014
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Published: Ann Intern Med. 1999;130(2):161.
TO THE EDITOR:
One point about which the recent guideline and background paper on screening for thyroid disease (1, 2) is misleading and outdated is reflected by the statement in the guideline that serum thyroid-stimulating hormone (TSH) levels are undetectable in hyperthyroid patients. The detection limits of so-called sensitive or second-generation TSH assays (defined as having functional sensitivity of 0.1 to 0.2 mU/L) have gradually improved, and third-generation TSH assays (sensitivity, 0.01 to 0.02 mU/L) are available in many clinical laboratories. Levels of TSH are reported to be detectable with third-generation assays in 4% to 17% of patients with overt thyrotoxicosis in a general population (3) and in about 50% of pregnant women with hyperemesis gravidarum and hyperthyroidism (4). Fourth-generation TSH assays, which have another 10-fold increase in sensitivity, enable the measurement of TSH levels in even more patients with hyperthyroidism, although these assays are not in widespread clinical use.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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