ESTIMATION OF TISSUE HYPOTHYROIDISM BY A NEW CLINICAL SCORE - EVALUATION OF PATIENTS WITH VARIOUS GRADES OF HYPOTHYROIDISM AND CONTROLS

The classical signs and symptoms of hypothyroidism were reevaluated in the light of the modern laboratory tests for thyroid function. We ana lyzed 332 female subjects: 50 overt hypothyroid patients, 93 with subc linical hypothyroidism (SCH), 67 hypothyroid patients treated with T-4 , and 189 euthyroid subjects. The clinical score was defined as the su m of the 2 best discriminating signs and symptoms. Beside TSH and thyr oid hormones, we measured parameters known to reflect tissue manifesta tions of hypothyroidism, such as ankle reflex relaxation time and tota l cholesterol. Classical signs of hypothyroidism were present only in patients with severe overt hypothyroidism with low T-3, but were rare or absent in patients with normal T-3, but low free T-4, or in patient s with SCH (normal thyroid hormones but elevated basal TSH; mean score s, 7.8 +/- 2.7 vs. 4.4 +/- 2.2 vs. 3.4 +/- 2.0; P < 0.001). Assessment of euthyroid subjects and T-4-treated patients revealed very similar results (mean score, 1.6 +/- 1.6 us. 2.1 +/- 1.5). In overt hypothyroi d patients, the new score showed an excellent correlation with ankle r eflex 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 wit h free T-4 was r = -0.52 (P < 0.0004); and that with T-3 was r = -0.56 (P < 0.0001). In SCH, the best correlation was found between the new score and free T-4 (r = -0.41; P < 0.0001) and TSH (r = 0.35; P < 0.00 05). Evaluation of symptoms and signs of hypothyroidism with the new s core in addition to thyroid function testing is very useful for the in dividual assessment of thyroid failure and the monitoring of treatment .