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Clinical Assessment and Systemic Manifestations of Hypothyroidism: Diagnostic Accuracy

المؤلف:  Wass, J. A. H., Arlt, W., & Semple, R. K. (Eds.).

المصدر:  Oxford Textbook of Endocrinology and Diabetes

الجزء والصفحة:  3rd edition , p539-540

2026-04-29

285

Several attempts have been made to develop a clinical score system, based on the most frequent symptoms and signs of hypothyroidism, that could accurately predict the diagnosis of thyroid failure in individual patients. In the 1960s, Billewicz et al. described a diagnostic index that scored the presence or absence of various signs and symptoms of hypothyroidism. However, at that time, modern laboratory thyroid function tests were not available to validate the diagnostic accuracy of such a score. Recently a convenient clinical score has been proposed by Zulewski et al. that is both easy to perform and sensitive for individual assessment of the severity of thyroid failure. The frequencies of the 14 more common symptoms and signs of overt hypothyroidism are shown in Table 1. The most common features in hypothyroid patients were prolonged ankle reflex (77%) and complaints about dry skin (76%). A reduced pulse rate and cold intolerance were recorded with a high frequency in euthyroid controls and were, therefore, excluded from this score. The sensitivity and specificity of each symptom and sign of hypothyroidism and the analysis of their positive and negative predictive values are shown in Table 1. Table 2 shows the scoring system of symptoms and signs of hypothyroidism. Because a correlation analysis revealed a significant correlation of these scores with age, a simple age correcting factor was defined by adding 1 point to the sum of symptoms and signs in women younger than 55 years. According to this analysis, the following diagnostic ranges for the clinical judgement with the age- corrected score were defined: hypothyroid, more than 5 points; euthyroid, 0– 2; intermediate, 3– 5 points.

Table1. Sensitivity and specificity of the 14 symptoms and signs of hypothyroidism and analysis of their positive and negative predictive values

Table2. Scoring of symptoms and signs of hypothyroidism