title: Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark carle@dadlnet.dk.
authors.forename: Allan
authors.initials: A
authors.lastname: Carlé
authors.affiliation: Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark.
authors.forename: Inge Bülow
authors.initials: IB
authors.lastname: Pedersen
authors.affiliation: Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark.
authors.forename: Nils
authors.initials: N
authors.lastname: Knudsen
authors.affiliation: Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Perrild
authors.affiliation: Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Ovesen
authors.affiliation: Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Laurberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D050031:Hashimoto Disease / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011336:Probability; D012720:Severity of Illness Index; D013967:Thyroiditis, Autoimmune; D055815:Young Adult