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Hypothyroid Symptoms Fail to Predict Thyroid Insufficiency in Old People: A Population-Based Case-Control Study

Carlé, Allan, Pedersen, Inge Bülow, Knudsen, Nils, Perrild, Hans, Ovesen, Lars, Andersen, Stig, Laurberg, Peter·2016·The American Journal of Medicine
DOI 10.1016/j.amjmed.2016.06.013
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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.

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  • In a US case-control study that assessed 17 self-reported hypothyroid symptoms, 76 patients with overt hypothyroidism reported a higher mean percentage of positive hypothyroid symptom responses (30.2%) compared with 147 matched controls (16.5%; P < .001).

    “In a US case-controlstudy 53 thatassessed17self-reportedhypothyroidsymptoms,76patientswithoverthypothyroidismreportedahighermean percentageofpositivehypothyroidsymptomresponses(30.2%)compared with 147 matched controls (16.5%; P &lt; .001).”

    From Hypothyroidism: A Review (2025) · cites this paper as [53]

  • Although hypothyroidism-associated symptoms may indicate hypothyroidism in most young patients, this is rarely the case in the elderly.

    “Although hypothyroidism-associated symptoms may indicate and identify hypothyroidism in most young patients, this is rarely the case in the elderly (16).”

    From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [16]

  • Since symptoms and patient-experienced manifestations of hypothyroidism are vaguer among the elderly, effects observed in younger populations cannot unquestionably be extrapolated to older ones.

    “However, since symptoms and thus the patient-experienced manifestations of hypothyroidism are vaguer among the elderly (16), effects observed in younger populations cannot unquestionably be extrapolated to older ones.”

    From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [16]

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Authors
Carlé, A., Pedersen, I. B., Knudsen, N., Perrild, H., Ovesen, L., Andersen, S., & Laurberg, P.
Affiliations
  • Aalborg University Hospital (DK)
  • Bispebjerg Hospital (DK)
  • Slagelse Hospital (DK)
Corresponding author
Carlé, Allan
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
2016-10
Volume
129
Issue
10
Pages
1082-1092
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/j.amjmed.2016.06.013
OpenAlex
W2465792087
Semantic Scholar
9140c4369fd94527b2f5ca380a3cd964e3049442
Cited by
91
References
11
Citations by year
2026: 4 · 2025: 14 · 2024: 5 · 2023: 11 · 2022: 13 · 2021: 14 · 2020: 6 · 2019: 12 · 2018: 6 · 2017: 5 · 2016: 1
FWCI
8.03
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
  • Scopus (Elsevier) (submittedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords
hypothyroidism, autoimmune hypothyroidism, symptom scores, older adults, age differences, thyroid-stimulating hormone, total thyroxine, symptom duration, diagnostic accuracy, dyspnea, wheezing, young men, women
MeSH terms
Adult, Aged, Autoantibodies, Dyspnea, Fatigue, Female, Humans, Iodide Peroxidase, Male, Middle Aged, Surveys and Questionnaires, Respiratory Sounds, ROC Curve, Sex Factors, Thyroiditis, Autoimmune, Thyrotropin, Thyroxine, Odds Ratio, Case-Control Studies, Hashimoto Disease

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