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Do traditional symptoms of hypothyroidism correlate with biochemical disease?

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Canaris, Gay J., Steiner, John F., Ridgway, E. Chester·1997·Journal of General Internal Medicine
DOI 10.1046/j.1525-1497.1997.07109.xPMC PMC1497160
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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.

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  • The most common symptoms of hypothyroidism in adults are lethargy, fatigue, cold intolerance, weight gain, hoarse voice, and dry skin.

    “The most common symptoms of hypothyroidism in adults are lethargy, fatigue, cold intolerance, weight gain, hoarse voice, and dry skin.4”

    From Hypothyroidism (2024) · cites this paper as [4]

    In the Results (Table 2; page not specified), dry skin, cold sensitivity, and tiredness were reported by 71%, 51%, and 40% of hypothyroid patients, respectively. Hoarse voice was reported by only 17%, so the table does not establish it as one of the most common symptoms. The paper does not report weight gain or lethargy as distinct symptoms. (LLM, conf=0.88)

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  • Many signs and symptoms of thyroid dysfunction are neither sensitive nor specific.

    “Many signs and symptoms of thyroid dysfunction are neither sensitive nor specific (57).”

    From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [57]

    The discussion passage labeled FIGURE 1 (page not specified) says hypothyroid symptoms are nonspecific and that few hypothyroid subjects report any individual symptom, supporting low specificity and sensitivity. The study addresses symptoms of hypothyroidism, not signs or thyroid dysfunction more broadly. (LLM, conf=0.84)

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  • The classic symptoms of hypothyroidism include fatigue, lethargy, weight gain, and cold intolerance, but these symptoms are nonspecific.

    “The classic symptoms of hypothyroidism include fatigue, lethargy, weight gain, and cold intolerance; however, these symptoms are nonspecific and the diagnosis is typically made on biochemical grounds through serum thyroid function tests.”

    From Hypothyroidism (2024) · cites this paper as [4]

    The introductory passage says classic hypothyroid symptoms may be nonspecific and that clinicians use biochemical measures for diagnosis. The Results list tiredness and cold sensitivity, but our copy does not identify weight gain as a classic symptom; a search for “weight gain” found no matching passage. The indexed passages do not provide specific page numbers. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Symptoms consistent with the presence of hypothyroidism are non-specific and cannot be reliably used to differentiate individuals with hypothyroidism from euthyroid controls.

    “However, symptoms consistent with the presence of hypothyroidism are non-specific and cannot be reliably used to differentiate individuals with hypothyroidism from euthyroid controls.4”

    From Hypothyroidism (2024) · cites this paper as [4]

    The discussion (Figure 1, p. 548–549) describes hypothyroid symptoms as nonspecific and says they cannot identify disease as well as thyroid-function tests. But the blanket claim that symptoms cannot reliably differentiate the groups overstates the result: changed symptoms distinguished those with and without elevated TSH 72% of the time, and patients reporting more or newly developed symptoms were more likely to have hypothyroidism. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Several studies report a correlation between signs and symptoms of hypothyroidism and biochemical disease, based either on an increasing cumulative number of symptoms or on an abnormal clinical score.

    “Several studies report a correlation between signs and symptoms of hypothyroidism and biochemical disease either based on an increasing cumulative number of symptoms (57) or on an abnormal clinical score (58).”

    From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [57]

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Cites

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Research works printed but not linked: 4

  1. Evered DC, Ormston BJ, Smith PA, Bird T. Grades of hypothyroid- ism. BMJ. 1973;1:657-62.
  2. Tachman ML, Guthrie GP. Hypothyroidism: diversity of presenta- tion. Endocr Rev. 1984;5:456-65.
  3. Billewicz WZ, Chapman RS, Crooks J, et al. Statistical methods ap- plied to the diagnosis of hypothyroidism. QJM. 1969;38:255-66.
  4. Cooper DS, Halpern R, Wood LC, Levin AA, Ridgway EC. L-Thyroxine therapy in subclinical hypothyroidism. Ann Intern Med. 1984;101: 18-24.

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Authors
Canaris, G. J., Steiner, J. F., & Ridgway, E. C.
Affiliations
  • University of Nebraska Medical Center (US)
  • University of Colorado Health (US)
ORCID
Steiner, John F.
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
1997-09
Volume
12
Issue
9
Pages
544-550
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1046/j.1525-1497.1997.07109.x
PMC
PMC1497160
OpenAlex
W1984653373
Cited by
172
References
37
Citations by year
2026: 2 · 2025: 5 · 2024: 7 · 2023: 12 · 2022: 7 · 2021: 7 · 2020: 12 · 2019: 21 · 2018: 8 · 2017: 5 · 2016: 7 · 2015: 7 · 2014: 11 · 2013: 10 · 2012: 9
FWCI
0.47
Type
journal article
Language
en
Open access
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Center for Research Resources (RR-00051)
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, thyroid-stimulating hormone, overt hypothyroidism, symptom screening, thyroid function tests, symptom change over time
MeSH terms
Adult, Aged, Cross-Sectional Studies, Female, Humans, Hypothyroidism, Male, Middle Aged, ROC Curve, Thyrotropin, Likelihood Functions, Case-Control Studies

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