Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case–control study

Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case–control study

So many people here report a wide range of symptoms, but still don't get tested at all. This paper rather confirms that having any symptom is a rational basis for testing. You don't have to have a full house!

I'd argue than a lot of people simply don't recognise their own symptoms either when they are going downhill, when diagnosed, and quite possibly not even when treated and (hopefully) recovered. I know I have to pinch myself to remember some of the issues I noticed. And the chances of medics noticing many of them are also quite low.

Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case–control study

Allan Carlé1,2⇑,

Inge Bülow Pedersen1,

Nils Knudsen3,

Hans Perrild3,

Lars Ovesen4 and

Peter Laurberg1,5

+ Author Affiliations

1Department of Endocrinology, Aalborg University Hospital, DK-9000 Aalborg, Denmark

2Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark

3Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark

4Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark

5Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Correspondence should be addressed to A Carlé; Email: carle@dadlnet.dk


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.

Received 13 June 2014

Revised version received 22 July 2014

Accepted 6 August 2014

© 2014 European Society of Endocrinology



1 Reply

  • Rod, nice find, thanks for posting. PR

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