Endocrine Abstracts

Introduction: Symptoms of hypothyroidism are very variable and are frequently present in the healthy population. The diagnosis can easily be missed if considered only in patients with classical symptoms. Aim: To describe the range of presentations in patients diagnosed with hypothyroidism in primary care.

Method: Patients were recruited via the British Thyroid Foundation and from a local GP surgery. Respondents were asked to complete a questionnaire for the main reason(s) that brought them to consult their GP, date of onset of symptoms, thyroid tests results at diagnosis, the presence of specific symptoms and the use of kelp supplements.

Results: 51 hypothyroid patients (F: M 45:6, age 15–81) were studied; 90% had been diagnosed within the last two years. For the whole group, the commonest main presenting symptoms were fatigue (33%) and weight gain (12%). The most frequent pre-existing specific symptoms on direct questioning were fatigue (88%), poor memory/ concentration (82%), weight gain (71%), muscle/ joint pains (65%), depression (65%), dry skin (63%), muscle weakness(61%) and cold intolerance (57%). In 57% of respondents these symptoms had been present for more than 12 months before the diagnosis was made. Respondents were categorised as early compensated subclinical hypothyroidism (TSH 4.5–10; FT4: N) - Group 1 (n=12), subclinical hypothyroidism (TSH>10; FT4:N) - Group 2 (n=14) and overt hypothyroidism (TSH>10; FT4< NR) - Group 3 (n=21). 4 were uncategorized due to insufficient data. Surprisingly, fatigue was a more common presentation in Group 1 (58%) than in Group 2 or 3 (21%& 24%). Overall 20% (16%, 41% & 19% of Group 1,2&3) presented with a variety of non-specific symptoms or incidentally during routine health check. 10% of respondents (29% Group 2) admitted to taking kelp.

Conclusion: Patients with varying degrees of thyroid deficiency often present with non-specific symptoms and detection requires a high degree of clinical suspicion.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.