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Do traditional symptoms of hypothyroidism correlate with biochemical disease?
Open accessAbstract
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.4”
From Hypothyroidism (2024) · cites this paper as [4]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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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“Due to the variable nature of symptoms and an absence of clear symptom specificity, 4 hypothyroidism is largely a bio-chemical diagnosis.”
From Hypothyroidism (2024) · cites this paper as [4]
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“A higher number of symptoms was also weakly correlated with higher TSH concentrations.4”
From Hypothyroidism (2024) · cites this paper as [4]
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“However,anin-hospitalmortalityrateofupto30% also has been reported; a difference in the estimates may depend onthedefinitionofmyxedemacoma,thestudydesign,andthegeographic location. 52”
From Hypothyroidism: A Review (2025) · cites this paper as [52]
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Metadata
- 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
- Published
- 1997-09
- Volume
- 12
- Issue
- 9
- Pages
- 544-550
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- 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
- bronze
- doi.org
- 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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