Estimation of Tissue Hypothyroidism by a New Clinical Score: Evaluation of Patients with Various Grades of Hypothyroidism and Controls1

Abstract

The classical signs and symptoms of hypothyroidism were reevaluated in the light of the modern laboratory tests for thyroid function. We analyzed 332 female subjects: 50 overt hypothyroid patients, 93 with subclinical hypothyroidism (SCH), 67 hypothyroid patients treated with T4, and 189 euthyroid subjects. The clinical score was defined as the sum of the 2 best discriminating signs and symptoms. Beside TSH and thyroid hormones, we measured parameters known to reflect tissue manifestations of hypothyroidism, such as ankle reflex relaxation time and total cholesterol. Classical signs of hypothyroidism were present only in patients with severe overt hypothyroidism with low T3, but were rare or absent in patients with normal T3 but low free T4 or in patients with SCH (normal thyroid hormones but elevated basal TSH; mean scores, 7.8 +/- 2.7 vs. 4.4 +/- 2.2 vs. 3.4 +/- 2.0; P < 0.001). Assessment of euthyroid subjects and T4-treated patients revealed very similar results (mean score, 1.6 +/- 1.6 vs. 2.1 +/- 1.5). In overt hypothyroid patients, the new score showed an excellent correlation with ankle reflex relaxation time and total cholesterol (r = 0.76 and r = 0.60; P < 0.0001), but no correlation with TSH (r = 0.01). The correlation with free T4 was r = -0.52 (P < 0.0004), and that with T3 was r = -0.56 (P < 0.0001). In SCH, the best correlation was found between the new score and free T4 (r = -0.41; P < 0.0001) and TSH (r = 0.35; P < 0.0005). Evaluation of symptoms and signs of hypothyroidism with the new score in addition to thyroid function testing is very useful for the individual assessment of thyroid failure and the monitoring of treatment.

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

“…Certainly, thyroid hormones have an important role in energy metabolism and hypothyroidism could indeed induce weight gain by means of both an increasing fat mass, due to mild decrease in resting energy expenditure and reduced physical activity, and also fluid retention, due to glycosaminoglycans accumulation (20,27). However, despite weight gain being a frequent complaint in hypothyroidism (28), it is usually of limited extent (27). In line, treatment of overt hypothyroidism produces only a modest weight loss (usually of less than 10%) (29,30,31), indicating that severe obesity is usually not secondary to hypothyroidism.…”

Detecting True Change in the Hospital Anxiety and Depression Scale, SF-36, and Hypothyroid Score when Monitoring Patients with Subclinical Hypothyroidism

“…The questionnaires used were: Danish version 1 of the SF-36 [13], a Danish version of the Hospital Anxiety and Depression Scale (HADS) [14], and the hypothyroid score as published by Zulewski et al [15]. …”

“…The patients evaluated the seven symptoms (diminished sweating, hoarseness paraesthesia, dry skin, constipation, impairment of hearing, and weight increase) whereas the five hypothyroid signs (slow movements, delayed ankle reflex, coarse skin, and periorbital puffiness) were evaluated by a physician (J.K.). With this clinical score hypothyroid patients generally score five or more while euthyroid subjects score two or less [15]. In the original score women aged below 55 years received one extra point.…”

Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options

“…Depending on the severity of the deficiency, the manifestation of clinical disease may vary from an entirely asymptomatic presentation to the typical yet complex hypothyroid syndrome produced by the many signs and symptoms of thyroid hormone deficiencies, and, more rarely, to the extreme of myxoedemic coma. Clinical scores have been developed but have demonstrated only limited sensitivity and specificity 41,42…”