Clinical scoring system for hypothyroidism: is it useful?

A clinical scoring system for hypothyroidism was evaluated against an established "gold standard" (low serum thyroxine and elevated thyroid-stimulating hormone) in 52 adults in a peripheral hospital and in 53 adults in a endocrinology referral clinic. Using a score of 0 as a cutoff point, the scoring system selected patients with hypothyroidism from the referral center for further biochemical evaluation; at the same time, it excluded hypothyroidism with confidence in 42% of euthyroid subjects. In the peripheral hospital, a cutoff score of -10 selected 92% of hypothyroid subjects for further evaluation and excluded hypothyroidism in 55% of euthyroid subjects. Two cutoff points were needed because the prevalences of hypothyroidism in the two centers differed. The simple scoring system increased the pretest probability of disease by 15% in the peripheral hospital and by 19% in the referral clinic. In countries where resources are limited, this scoring system can improve the clinical evaluation of patients who have one or more symptoms of hypothyroidism and reduce the load on referral centers.