Published 11 August 2008, doi:10.1136/bmj.a1259
Cite this as: BMJ 2008;337:a1259

Letters

Subclinical hypothyroidism

Let’s identify research questions

The first 150 words of the full text of this article appear below.

The summary of what is unknown about the management of clinical hypothyroidism by Pham and Shaughnessy seems to have missed a prime opportunity to identify the key research questions that would address the evidence gap—preferably in a PICO (population, intervention, comparison, and outcome ) format.^{1 2}

The authors—who have conducted a systematic review on this topic—are best placed to know the evidence gaps and hence identify the research questions which need answering. Even if they themselves had no inclination to do the research, publication here would enable researchers to take those questions, find funding, and answer them.

As is, the recommendations on how to deal with subclinical hypothyroidism constitute a mix of common sense (don’t screen for this condition), best guesses (try treating it for a few months), and ignorance of the natural history of subclinical hypothyroidism (check thyroid stimulating hormone every year).

There is a big evidence gap here—amenable to . . . [Full text of this article]

¹ National Institute for Health Research Coordinating Centre for Health Technology Assessment, University of Southampton, Southampton SO16 7NS

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