Allan Carlé1, Inge Bülow Pedersen2, Nils Knudsen2, Hans Perrild2, Lars Ovesen2, Peter Laurberg3. 1. Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark carle@dadlnet.dk. 2. Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark. 3. Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark.
Abstract
BACKGROUND: It is generally accepted that patients suffering from hypothyroidism may express few symptoms, but this has not been studied in a population-based study design. OBJECTIVES: To study the array of symptoms as they are reported in newly diagnosed overt autoimmune hypothyroidism using a population-based case-control design. METHODS: Patients with new overt autoimmune hypothyroidism (n=140) and their individually matched thyroid disease-free controls (n=560) recruited from the same population underwent a comprehensive program and self-reported a number of symptoms. We identified the symptoms associated with overt hypothyroidism and calculated positive (LR+) and negative (LR-) likelihood ratios as well as diagnostic odds ratios (DORs) as measures for the association between disease state and symptoms. RESULTS: Among 34 symptoms investigated, 13 symptoms were statistically overrepresented in hypothyroidism. Hypothyroid patients suffered mostly from tiredness (81%), dry skin (63%), and shortness of breath (51%). Highest DORs (95% CI) were reported for tiredness (5.94 (3.70-9.60)), hair loss (4.58 (2.80-7.51)), and dry skin (4.09 (2.73-6.16)). A hypothyroidism-component-score was defined as the number of hypothyroidism-associated symptoms (range: 0-13). LR+ for participants with a hypothyroidism-component-score of 0 was 0.21 (0.09-0.39), meaning that the post-test probability was lowered to 21% of what it was before asking for symptoms. LR+ for scores of 1-2/3/4-6/7-9/10-13 were: 0.47 (0.30-0.72)/1.16 (0.70-1.87)/1.90 (1.29-2.45)/3.52 (2.30-5.36)/6.29 (2.30-17.7). CONCLUSIONS: None of the individual symptoms of hypothyroidism had high LRs or DORs. Thus, neither the presence nor absence of any individual hypothyroidism symptom was reliable in the decision making of who should have their thyroid function tested. Therefore, even minor suspicion should lead to a blood test.
BACKGROUND: It is generally accepted that patients suffering from hypothyroidism may express few symptoms, but this has not been studied in a population-based study design. OBJECTIVES: To study the array of symptoms as they are reported in newly diagnosed overt autoimmune hypothyroidism using a population-based case-control design. METHODS:Patients with new overt autoimmune hypothyroidism (n=140) and their individually matched thyroid disease-free controls (n=560) recruited from the same population underwent a comprehensive program and self-reported a number of symptoms. We identified the symptoms associated with overt hypothyroidism and calculated positive (LR+) and negative (LR-) likelihood ratios as well as diagnostic odds ratios (DORs) as measures for the association between disease state and symptoms. RESULTS: Among 34 symptoms investigated, 13 symptoms were statistically overrepresented in hypothyroidism. Hypothyroidpatients suffered mostly from tiredness (81%), dry skin (63%), and shortness of breath (51%). Highest DORs (95% CI) were reported for tiredness (5.94 (3.70-9.60)), hair loss (4.58 (2.80-7.51)), and dry skin (4.09 (2.73-6.16)). A hypothyroidism-component-score was defined as the number of hypothyroidism-associated symptoms (range: 0-13). LR+ for participants with a hypothyroidism-component-score of 0 was 0.21 (0.09-0.39), meaning that the post-test probability was lowered to 21% of what it was before asking for symptoms. LR+ for scores of 1-2/3/4-6/7-9/10-13 were: 0.47 (0.30-0.72)/1.16 (0.70-1.87)/1.90 (1.29-2.45)/3.52 (2.30-5.36)/6.29 (2.30-17.7). CONCLUSIONS: None of the individual symptoms of hypothyroidism had high LRs or DORs. Thus, neither the presence nor absence of any individual hypothyroidism symptom was reliable in the decision making of who should have their thyroid function tested. Therefore, even minor suspicion should lead to a blood test.
Authors: Luba Freja Michaelsson; Bjarke Borregaard Medici; Jeppe Lerche la Cour; Christian Selmer; Michael Røder; Hans Perrild; Nils Knudsen; Jens Faber; Birte Nygaard Journal: Eur Thyroid J Date: 2015-08-14
Authors: Laszlo Hegedüs; Antonio C Bianco; Jacqueline Jonklaas; Simon H Pearce; Anthony P Weetman; Petros Perros Journal: Nat Rev Endocrinol Date: 2022-01-18 Impact factor: 47.564