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.