In his response about monitoring amiodarone levels (Item 113-6), Dr. Cohn missed an opportunity to remind readers ofthe need for yearly eye exams as well as regular annual monitoring of thyroid function tests,chest radiography,and spirometry. I also make sure my patients understand the risk of thyroid disease,pulmonary toxicity, and optic neuropathy and counsel them to see their ophthalmologist immediately for any changes in vision. And of course, I document these conversations in their chart.
—Ronald L. Hirsch, MD, Elgin, Ill.

Dr. Hirsch is absolutely correct in urging monitoring for thyroid and pulmonary complications, especially in patients who are younger than the 85-year-old woman in the original question and might be on the drug for an extended period of time.
—Peter F.Cohn, MD (114-27)

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