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Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case–control study

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Carlé, Allan, Pedersen, Inge Bülow, Knudsen, Nils, Perrild, Hans, Ovesen, Lars, Laurberg, Peter·2014·European Journal of Endocrinology
DOI 10.1530/eje-14-0481
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Abstract

Background: It is generally accepted that patients suffering from hypothyroidism may express few symptoms, but this has not been studied in a population-based study design. Objectives: To study the array of symptoms as they are reported in newly diagnosed overt autoimmune hypothyroidism using a population-based case–control design. Methods: Patients with new overt autoimmune hypothyroidism (n=140) and their individually matched thyroid disease-free controls (n=560) recruited from the same population underwent a comprehensive program and self-reported a number of symptoms. We identified the symptoms associated with overt hypothyroidism and calculated positive (LR+) and negative (LR−) likelihood ratios as well as diagnostic odds ratios (DORs) as measures for the association between disease state and symptoms. Results: Among 34 symptoms investigated, 13 symptoms were statistically overrepresented in hypothyroidism. Hypothyroid patients suffered mostly from tiredness (81%), dry skin (63%), and shortness of breath (51%). Highest DORs (95% CI) were reported for tiredness (5.94 (3.70–9.60)), hair loss (4.58 (2.80–7.51)), and dry skin (4.09 (2.73–6.16)). A hypothyroidism-component-score was defined as the number of hypothyroidism-associated symptoms (range: 0–13). LR+ for participants with a hypothyroidism-component-score of 0 was 0.21 (0.09–0.39), meaning that the post-test probability was lowered to 21% of what it was before asking for symptoms. LR+ for scores of 1–2/3/4–6/7–9/10–13 were: 0.47 (0.30–0.72)/1.16 (0.70–1.87)/1.90 (1.29–2.45)/3.52 (2.30–5.36)/6.29 (2.30–17.7). Conclusions: None of the individual symptoms of hypothyroidism had high LRs or DORs. Thus, neither the presence nor absence of any individual hypothyroidism symptom was reliable in the decision making of who should have their thyroid function tested. Therefore, even minor suspicion should lead to a blood test.

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Authors
Carlé, A., Pedersen, I. B., Knudsen, N., Perrild, H., Ovesen, L., & Laurberg, P.
Affiliations
Aalborg University Hospital (DK)
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2014-11
Volume
171
Issue
5
Pages
593-602
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-14-0481
OpenAlex
W2137843402
Cited by
95
References
40
Citations by year
2026: 4 · 2025: 7 · 2024: 14 · 2023: 12 · 2022: 9 · 2021: 7 · 2020: 7 · 2019: 10 · 2018: 4 · 2017: 7 · 2016: 7 · 2015: 7
FWCI
5.63
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders
  • Aalborg Universitetshospital
  • Bispebjerg Hospital
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-based diagnosis, likelihood ratios, diagnostic odds ratio, fatigue, dry skin, hair loss, dyspnea, thyroid function tests, diagnostic accuracy, symptom scores, post-test probability, thyroid screening, self-reported symptoms, diagnostic decision-making, population-based study
MeSH terms
Adolescent, Adult, Aged, Female, Humans, Hypothyroidism, Male, Middle Aged, Probability, Severity of Illness Index, Thyroiditis, Autoimmune, Case-Control Studies, Hashimoto Disease, Young Adult

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