In Reply.—Dr Lee's first point cannot be answered directly, since the population served by the Los Angeles County/USC Medical Center pediatric Diabetic Clinic is 90% to 95% Hispanic. There were not enough white or black patients to provide an internal comparison of the prevalence of AMAs, and we were forced to rely on data in the literature for this purpose.
The main questions raised by Dr Lee concern the process of laboratory screening for thyroid dysfunction, the clinical evaluation of thyroid function in patients with diabetes, and the indications for treatment in this population. We recommended screening for thyroid autoimmunity with laboratory assessment of thyroid funtion in those patients who are found to have circulating AMAs. This approach first asks a pathogenetic question and reserves laboratory assessment of thyroid function for those patients found to have a marker of thyroid autoimmunity. As Dr Lee indicates, the assessment of autoimmunity must