Why are we still discussing optimal strategies for thyroid-related investigations around anecdotes of individual patients? It shouldn't be too hard to work out if doing that TSH is worth it or not. You'd need some estimates of prevalence of undiagnosed hypopituitarism, benefit of detecting and treating it, disbenefits around patients who have to be investigated further but turn out not to need intervention, a few unit costs etc. Then you could work out something like incremental cost-effectiveness ratio in £/ QALY, and numbers needed to investigate.
Or perhaps someone has already done this, and presented it?
Jonathan
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