Biochemical testing on wide indication to detect overt hypothyroidism is justified: a population-based case[ndash]control study in patients newly diagnosed with overt autoimmune hypothyroidism

Allan Carle; Inge Bulow Pedersen; Nils Knudsen; Lars Ovesen; Lone Banke Rasmussen; Torben Jorgensen; Hans Perrild; Peter Laurberg

doi:10.1530/endoabs.32.P1014

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Endocrine Abstracts (2013) 32 P1014 | DOI: 10.1530/endoabs.32.P1014

ECE2013 Poster Presentations Thyroid (non-cancer) (100 abstracts)

Biochemical testing on wide indication to detect overt hypothyroidism is justified: a population-based case–control study in patients newly diagnosed with overt autoimmune hypothyroidism

Allan Carlé ¹ , Inge Bülow Pedersen ¹ , Nils Knudsen ² , Lars Ovesen ³ , Lone Banke Rasmussen ⁴ , Torben Jørgensen ^5, , Hans Perrild ² & Peter Laurberg ^1,

Err

Author affiliations

¹Department of Endocrinology and Medicine, Aalborg University Hospital, Aalborg, Denmark; ²Endocrine Unit, Medical Clinic I, Bispebjerg Hospital, Copenhagen, Denmark; ³Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark; ⁴Ministry of Food, Agriculture and Fisheries, National Food Institute, Technical University of Denmark, Copenhagen, Denmark; ⁵Research Centre for Disease Prevention and Health, Copenhagen, Denmark; ⁶Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark; ⁷Faculty of Medicine, University of Aalborg, Aalborg, Denmark.

Objectives: Hypothyroid patients report a diversity of symptoms at disease presentation. We studied how useful symptoms are to predict hypothyroidism, and if this may vary between subgroups of patients.

Methods: Patients newly diagnosed with overt autoimmune hypothyroidism (n=140) were prospectively identified in a population by linkage to diagnostic laboratory databases, and we concomitantly enrolled individually sex and age-region matched controls (n=560). Patients and controls participated in a comprehensive investigational program including the presence of 36 symptoms. Sensitivity and diagnostic odds ratios (DOR, >1 significant, >10 very useful as a diagnostic tool) were calculated. In multivariate models, we identified predictors for presence of each symptom. Subgroup analysis was performed in three age groups (tertiles, group A/B/C=0–48.1 years/48.1–58.2 years/58.2 years).

Results: 13 of 36 symptoms were more frequent (DOR >1) among patients than in controls. DOR was highest for tiredness=5.94 (3.70–9.60 (95% CI)), feeling unwell=4.10 (2.57–6.54), hair loss=4.58 (2.80–7.71), and dry skin=4.09 (2.73–6.16). Tiredness and feeling unwell were independent of age, but age was a predictor for globulus sensation (only present in the two younger age groups (+/+/−)), swallowing difficulties (+/+/−), anterior neck pain (+/+/−), restlessness (+/+/−), cardiac palpitations (+/−/−), bad mood (+/+/−), constipation (+/+/−), decreased appetite (+/+/−), hair loss (+/+/−), dry skin (+/+/−), and vertigo (+/+/−). Serum T₃ (but not TSH or T₄) was predictor for degree of tiredness, smoking for shortness of breath. No difference was observed between sexes, regions investigated, or alcohol intake level.

Conclusions: Symptom presentation did not differentiate very well between cases and controls, with great overlap especially in elderly people. Interestingly, symptoms were much more associated with age at presentation than with the biochemical degree of hypothyroidism at debut. Biochemical testing on wide indication to diagnose overt hypothyroidism is justified.