Skip to main content

Do traditional symptoms of hypothyroidism correlate with biochemical disease?

Journal of General Internal Medicine volume 12, pages 544–550 (1997)Cite this article

Abstract

Objective

Hypothyroidism often remains undetected because of the difficulty associating symptoms with disease. To determine the relation between symptoms and biochemical disease, we assessed symptoms and serum thyroid function tests, concurrently, for patients with and without hypothyroidism.

Design

Cross-sectional study.

Setting/Patients

Seventy-six newly diagnosed case patients with overt hypothyroidism and 147 matched control patients identified through outpatient laboratories in Michigan and Colorado.

Measurements and main results

Patient symptoms were assessed by questionnaire. Case patients reported a higher proportion of hypothyroid symptoms than did control patients (30.2% vs 16.5%,p<.0001). Univariate analysis identified three significant predictors of an elevated level of thyroid-stimulating hormone (TSH) (p<.05), and 13 symptoms which, when they had changed in the past year, were reported more often by case patients with hypothyroidism than by control patients (p<.005). Individuals reporting changes in 7 or more symptoms were significantly more likely to have hypothyroidism (likelihood ratio [LR]=8.7, 95% confidence interval [CI] 3.8, 20.2); those reporting changes in 2 or fewer symptoms were less likely to have hypothyroidism (LR=0.5, 95% CI 0.4, 0.7).

Conclusions

In this sample, the number of hypothyroid symptoms reported was directly related to the level of TSH. The association was stronger when more symptoms were reported. Symptoms that had changed in the past year were more powerful than symptoms reported present at the time of testing. This suggests that traditional symptoms are valuable when deciding which patients to test for hypothyroidism.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Evered DC, Ormston BJ, Smith PA, Bird T. Grades of hypothyroidism. BMJ 1973;1:657–62.

    PubMed  CAS  Google Scholar 

  2. Larsen PR, Ingbar SH. The thyroid gland. In: Wilson JD, Foster DW, eds. Williams Textbook of Endocrinology. Philadelphia, Pa: WB Saunders Co: 1992:357–487.

    Google Scholar 

  3. Wartofsky L, Ingbar SH. Diseases of the thyroid. In: Wilson JD, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 12th ed. New York, NY: McGraw-Hill: 1991: 1692–712.

    Google Scholar 

  4. Golding DN. Hypothyroidism presenting with musculoskeletal symptoms. Ann Rheum Dis. 1970;29:10–4.

    PubMed  CAS  Article  Google Scholar 

  5. Gavin LA. The diagnostic dilemmas of hyperthyroxinemia and hypothyroxinemia. Adv Intern Med. 1988;33:185–204.

    PubMed  CAS  Google Scholar 

  6. Tachman ML, Guthrie GP. Hypothyroidism: diversity of presentation. Endocr Rev. 1984;5:456–65.

    PubMed  CAS  Google Scholar 

  7. Schectman JM, Kallenberg GA, Shumacher RJ, Hirsch RP. Yield of hypothyroidism in symptomatic primary care patients. Arch Intern Med. 1989;149:861–4.

    PubMed  Article  CAS  Google Scholar 

  8. Bahemuka M, Hodkinson HM. Screening for hypothyroidism in elderly inpatients. BMJ. 1975;2:601–3.

    PubMed  CAS  Article  Google Scholar 

  9. Sawin CT, Chopra D, Azizi F, Mannix JE, Bacharach P. The aging thyroid. Increased prevalence of elevated serum thyrotropin levels in the elderly. JAMA. 1979;242:247–50.

    PubMed  Article  CAS  Google Scholar 

  10. Eggertsen R, Petersen K, Lundberg PA, Hystrom E, Lindstedt G. Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit. BMJ. 1988;297:1586–92.

    PubMed  CAS  Google Scholar 

  11. Danese MD, Powe NR, Sawin CT, Ladenson PW. Screening for mild thyroid failure at the periodic health examination. A decision and cost-effectiveness analysis. JAMA. 1996;276:285–92.

    Article  Google Scholar 

  12. Helfand M, Crapo LM. Screening for thyroid disease. Ann Intern Med. 1990;112:840–9.

    PubMed  CAS  Google Scholar 

  13. Singer PA, Cooper DS, Levy EG, et al. Treatment guidelines for patients with hyperthyroidism and hypothyroidism. JAMA. 1995;273:808–12.

    PubMed  Article  CAS  Google Scholar 

  14. Eddy DM. Common Screening Tests. Philadelphia, Pa: American College of Physicians; 1991.

    Google Scholar 

  15. American Academy of Family Physicians. Age Charts for Periodic Health Examination. Kansas City, Mo: American Academy of Family Physicians; 1994.

    Google Scholar 

  16. American Association of Clinical Endocrinologists. Clinical Practice Guidelines for the Evaluation of Hyperthyroidism and Hypothyroidism. Jacksonville, Fla: American Association of Clinical Endocrinologists and American College of Endocrinology; 1995.

    Google Scholar 

  17. U.S. Preventive Services Task Force. Screening for thyroid disease. In: Guide to Clinical Preventive Services. 2nd ed. Baltimore, Md: Williams and Wilkins; 1996:209–18.

    Google Scholar 

  18. Billewicz WZ, Chapman RS, Crooks J, et al. Statistical methods applied to the diagnosis of hypothyroidism. QJM. 1969;38:255–66.

    PubMed  CAS  Google Scholar 

  19. Seshadri MS, Samuel BU, Kanagasabapathy AS, Cherian AM. Clinical scoring system for hypothyroidism: is it useful? J Gen Intern Med. 1989;4:490–2.

    PubMed  Article  CAS  Google Scholar 

  20. White GH, Walmsley RN. Can the initial clinical assessment of thyroid function be improved? Lancet. 1978;2:933–5.

    PubMed  Article  CAS  Google Scholar 

  21. Nierenberg AA, Feinstein AR. How to evaluate a diagnostic marker test. Lessons from the rise and fall of dexamethasone suppression test. JAMA. 1988;259:1699–702.

    PubMed  Article  CAS  Google Scholar 

  22. Cooper DS, Halpern R, Wood LC, Levin AA, Ridgway EC.l-Thyroxine therapy in subclinical hypothyroidism. Ann Intern Med. 1984;101:18–24.

    PubMed  CAS  Google Scholar 

  23. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. 2nd ed. Boston, Mass: Little, Brown and Co.; 1991.

    Google Scholar 

  24. Jaeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature, III: how to use an article about a diagnostic test. B: what are the results and will they help me in caring for my patients? JAMA. 1994;271:703–7.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Nebraska Medical Center, 600 S. 42nd St., 68198-3331, Omaha, NE

    Gay J. Canaris MD, MSPH

  2. Department of Medicine, University of Colorado Health Sciences Center, Denver

    John F. Steiner MD, MPH

  3. Division of Endocrinology, University of Colorado Health Sciences Center, Denver

    E. Chester Ridgway MD

Authors
  1. Gay J. Canaris MD, MSPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John F. Steiner MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Chester Ridgway MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

The pilot to this study was presented as a poster at the regional meeting of the Society of General Internal Medicine, September 1995. The results of this study were presented as a poster at the annual meeting of the Society for Medical Decision Making, October 1996.

Supported by the General Clinical Research Center via U.S. Public Health Service Research Grant RR-00051 from the Division of Research Resources at the University of Colorado Health Sciences Center, and a Butterworth Foundation grant, Butterworth Hospital, Grand Rapids, Mich.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Canaris, G.J., Steiner, J.F. & Ridgway, E.C. Do traditional symptoms of hypothyroidism correlate with biochemical disease?. J GEN INTERN MED 12, 544–550 (1997). https://doi.org/10.1046/j.1525-1497.1997.07109.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.1997.07109.x

Key words

  • hypothyroidism
  • symptoms
  • diagnosis