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Estimation of Tissue Hypothyroidism by a New Clinical Score: Evaluation of Patients with Various Grades of Hypothyroidism and Controls¹

Division of Endocrinology, Department of Medicine, University Hospital of Basel, Basel, Switzerland

Address all correspondence and requests for reprints to: Jean-Jacques Staub, M.D., Division of Endocrinology, Department of Medicine, University Hospital of Basel, CH-4031 Basel, Switzerland.

The classical signs and symptoms of hypothyroidism were reevaluated in the light of the modern laboratory tests for thyroid function. We analyzed 332 female subjects: 50 overt hypothyroid patients, 93 with subclinical hypothyroidism (SCH), 67 hypothyroid patients treated with T₄, and 189 euthyroid subjects. The clinical score was defined as the sum of the 2 best discriminating signs and symptoms. Beside TSH and thyroid hormones, we measured parameters known to reflect tissue manifestations of hypothyroidism, such as ankle reflex relaxation time and total cholesterol.

Classical signs of hypothyroidism were present only in patients with severe overt hypothyroidism with low T₃, but were rare or absent in patients with normal T₃ but low free T₄ or in patients with SCH (normal thyroid hormones but elevated basal TSH; mean scores, 7.8 ± 2.7 vs. 4.4 ± 2.2 vs. 3.4 ± 2.0; P < 0.001). Assessment of euthyroid subjects and T₄-treated patients revealed very similar results (mean score, 1.6 ± 1.6 vs. 2.1 ± 1.5). In overt hypothyroid patients, the new score showed an excellent correlation with ankle reflex relaxation time and total cholesterol (r = 0.76 and r = 0.60; P < 0.0001), but no correlation with TSH (r = 0.01). The correlation with free T₄ was r = -0.52 (P < 0.0004), and that with T₃ was r = -0.56 (P < 0.0001). In SCH, the best correlation was found between the new score and free T₄ (r = -0.41; P < 0.0001) and TSH (r = 0.35; P < 0.0005).

Evaluation of symptoms and signs of hypothyroidism with the new score in addition to thyroid function testing is very useful for the individual assessment of thyroid failure and the monitoring of treatment.

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