brand logo

Am Fam Physician. 2002;66(2):online-only-

to the editor: I enjoyed the excellent review, entitled "Treatment of Hypothyroidism."1 However, the article does not address the issue of the clinical validity of thyrotropin-stimulating hormone (TSH) levels in patients recovering from major illness. It is known that TSH production is suppressed in severely ill patients and that there may be a temporary rebound to above-normal levels during convalescence. What does this say about the reliability of TSH results obtained shortly before or shortly after the patient is discharged from the hospital?

in reply: As Dr. Gillette points out, the measurement of thyroid-stimulating hormone (TSH) during episodes of acute illness can be inaccurate in some patients. Investigators have found that acute illness blunts the primary response to TSH, which would account for low TSH values during times of physiologic stress,1 producing falsely depressed TSH levels during illness. However, another group2 found that TSH levels were elevated during acute illness. Finally, a third study3 found both falsely depressed (9 percent of cases) and falsely elevated (4 percent of cases) TSH levels in geriatric patients with acute illness. Any abnormality in TSH obtained during an acute illness should be interpreted cautiously, and the thyroid status of the patient should be reexamined after recovery.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

Continue Reading


More in AFP

Copyright © 2002 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See https://www.aafp.org/about/this-site/permissions.html for copyright questions and/or permission requests.