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We thank Dr. Meyer for his interest in our study. We fully agree with him that the prevalence rate of subclinical hypothyroidism may vary significantly, being influenced by a number of factors.1 The clinical interpretation of our single-cohort epidemiological study2 should only aim to highlight the possibility for potential clinical correlation because comparison with the control group from the same population is required to extrapolate definite conclusions, as correctly indicated by Dr. Meyer. In our opinion, “big data” derived by large scale, control-matched epidemiological studies, which will incorporate different populations with patients with keratoconus, are the necessary tools to investigate this potential clinical association with increased validity.
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