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Diagnosis of Thyroid Dysfunction-Reply

Leo V. dos Remedios, MD
Arch Intern Med. 1982;142(3):646. doi:10.1001/archinte.1982.00340160226048.
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—To maximize screening sensitivity, we designated 2,267 patients who had an FT4I of 141 to 340 (normal, 121 to 360) plus total T4 levels of 5.5 to 10.4 μg/dL (normal, 4.5 to 11.4 μg/dL) as "highly probable euthyroid." Of these patients, one third were randomly selected for careful study, including their TSH levels. None had thyroid dysfunction. All remaining patient groups were similarly fully studied.

Of asymptomatic euthyroid patients, 1% had isolated high TSH levels (7 to 15 μU/mL). Evered et al1 defined such patients with normal FT4Is and some elevation of TSH levels as having "subclinical hypothyroidism," giving six of 22 thyroid medication without symptomatic change. We chose not to treat but to follow up those patients with subclinical hypothyroidism. All our symptomatic hypothyroid patients happened to have a low FT4I.

We found uncommon "T3 toxicosis," defined as a syndrome with


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