Allan Carlé1, Inge Bülow Pedersen2, Nils Knudsen3, Hans Perrild3, Lars Ovesen4, Stig Andersen5, Peter Laurberg6. 1. Department of Endocrinology, Aalborg University Hospital, Denmark; Diagnostic Centre, Region Hospital Silkeborg, Denmark. Electronic address: carle@dadlnet.dk. 2. Department of Endocrinology, Aalborg University Hospital, Denmark. 3. Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark. 4. Department of Internal Medicine, Slagelse Hospital, Denmark. 5. Department of Geriatry, Aalborg University Hospital, Denmark. 6. Department of Endocrinology, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
Abstract
BACKGROUND: Clinic-based studies have indicated that older hypothyroid patients may present only few symptoms. METHODS: In this population-based study of hypothyroidism, we investigated how the power of symptom presence predicts overt hypothyroidism in both young and older subjects. We identified patients newly diagnosed with overt autoimmune hypothyroidism in a population (n = 140, median thyroid-stimulating hormone, 54.5; 95% confidence interval [CI], 28.3-94.8; median total T4, 37; 95% CI, 18-52) and individually matched each patient with 4 controls free of thyroid disease (n = 560). Participants filled out questionnaires concerning the presence and duration of symptoms. We compared the usefulness of hypothyroidism-associated symptoms in predicting overt hypothyroidism in different age groups (young: <50 years, middle age: 50-59 years, old: ≥60 years) also taking various confounders into account. RESULTS: In young hypothyroid patients, all 13 hypothyroidism-associated symptoms studied were more prevalent than in their matched controls, whereas only 3 of those (tiredness, shortness of breath, and wheezing) were more prevalent in old patients. The mean numbers of symptoms presented at disease onset were 6.2, 5.0, and 3.6 at the ages of 0 to 49 years, 50 to 59 years, and 60+ years, respectively. In young versus old people with 0 to 1 symptoms, the odds ratio for being hypothyroid was 0.04 (95% CI, 0.007-0.18) versus 0.34 (95% CI, 0.15-0.78) (reference all other groups). In young versus old subjects reporting ≥4 symptoms, the odds ratio for being hypothyroid was 16.4 (95% CI, 6.96-40.0) versus 2.22 (95% CI, 1.001-4.90). Receiver operating characteristic analyses revealed that the symptom score was an excellent tool for predicting hypothyroidism in young men (area under the receiver operating characteristic curve, 0.91; 95% CI, 0.82-0.998), whereas it was poor in evaluating older women (area under the receiver operating characteristic curve, 0.64; 95% CI, 0.54-0.75). CONCLUSION: Hypothyroid symptom score is a good discriminating tool to identify hypothyroidism in young patients but fails to identify hypothyroidism in the elderly. Thus, thyroid function should be tested on wide indications in old age.
BACKGROUND: Clinic-based studies have indicated that older hypothyroidpatients may present only few symptoms. METHODS: In this population-based study of hypothyroidism, we investigated how the power of symptom presence predicts overt hypothyroidism in both young and older subjects. We identified patients newly diagnosed with overt autoimmune hypothyroidism in a population (n = 140, median thyroid-stimulating hormone, 54.5; 95% confidence interval [CI], 28.3-94.8; median total T4, 37; 95% CI, 18-52) and individually matched each patient with 4 controls free of thyroid disease (n = 560). Participants filled out questionnaires concerning the presence and duration of symptoms. We compared the usefulness of hypothyroidism-associated symptoms in predicting overt hypothyroidism in different age groups (young: <50 years, middle age: 50-59 years, old: ≥60 years) also taking various confounders into account. RESULTS: In young hypothyroidpatients, all 13 hypothyroidism-associated symptoms studied were more prevalent than in their matched controls, whereas only 3 of those (tiredness, shortness of breath, and wheezing) were more prevalent in old patients. The mean numbers of symptoms presented at disease onset were 6.2, 5.0, and 3.6 at the ages of 0 to 49 years, 50 to 59 years, and 60+ years, respectively. In young versus old people with 0 to 1 symptoms, the odds ratio for being hypothyroid was 0.04 (95% CI, 0.007-0.18) versus 0.34 (95% CI, 0.15-0.78) (reference all other groups). In young versus old subjects reporting ≥4 symptoms, the odds ratio for being hypothyroid was 16.4 (95% CI, 6.96-40.0) versus 2.22 (95% CI, 1.001-4.90). Receiver operating characteristic analyses revealed that the symptom score was an excellent tool for predicting hypothyroidism in young men (area under the receiver operating characteristic curve, 0.91; 95% CI, 0.82-0.998), whereas it was poor in evaluating older women (area under the receiver operating characteristic curve, 0.64; 95% CI, 0.54-0.75). CONCLUSION:Hypothyroid symptom score is a good discriminating tool to identify hypothyroidism in young patients but fails to identify hypothyroidism in the elderly. Thus, thyroid function should be tested on wide indications in old age.
Authors: Claudio Schneider; Martin Feller; Douglas C Bauer; Tinh-Hai Collet; Bruno R da Costa; Reto Auer; Robin P Peeters; Suzanne J Brown; Alexandra P Bremner; Peter C O'Leary; Peter Feddema; Peter J Leedman; Drahomir Aujesky; John P Walsh; Nicolas Rodondi Journal: PLoS One Date: 2018-04-30 Impact factor: 3.240
Authors: John E M Midgley; Anthony D Toft; Rolf Larisch; Johannes W Dietrich; Rudolf Hoermann Journal: BMC Endocr Disord Date: 2019-04-18 Impact factor: 2.763
Authors: Marco Vacante; Antonio Biondi; Francesco Basile; Roberto Ciuni; Salvatore Luca; Salomone Di Saverio; Carola Buscemi; Enzo Saretto Dante Vicari; Antonio Maria Borzì Journal: Front Endocrinol (Lausanne) Date: 2019-04-24 Impact factor: 5.555
Authors: Rudolf Hoermann; John E M Midgley; Rolf Larisch; Johannes W Dietrich Journal: Front Endocrinol (Lausanne) Date: 2019-09-26 Impact factor: 5.555