Thyrotoxicosis Diagnosis - Clinical Diagnostic Index

Description

Crooks et al developed a clinical index for the diagnosis of thyrotoxicosis based on a patient’s signs and symptoms. It can help in the initial evaluation of the patient and to monitor a patient over time. The authors are from the Western Infirmary in Glasgow, Scotland.

Parameters:

(1) 8 symptoms of recent onset or increased severity

(2) 11 signs

Clinical Symptom	Finding	Points
dyspnea on effort	present	+1
	absent	0
palpitations	present	+2
	absent	0
tiredness	present	+2
	absent	0
temperature preference	for heat	-5
	indifferent	0
	for cold	+5
excessive sweating	present	+1
	absent	0
nervousness	present	+1
	absent	0
appetite	increased	+3
	unchanged	0
	decreased	-3
weight	increased	-3
	unchanged	0
	decreased	+3

where:

• The preference for heat may be of any duration.

Sign	Finding	Points
palpable thyroid	present	+3
	absent	-3
bruit over thyroid	present	+2
	absent	-2
exophthalmos	present	+2
	absent	0
lid retraction	present	+2
	absent	0
lid lag	present	+1
	absent	0
hyperkinetic movements	present	+4
	absent	-2
fine finger tremor	present	+1
	absent	0
hands hot	present	+2
	absent	-2
hands moist	present	+1
	absent	-1
auricular/atrial fibrillation	present	+4
	absent	0
regular heart rate	< 80 beats per minute	-3
	80 – 90	0
	> 90	+3

symptom score =

= SUM(points for all 8 symptoms)

sign score =

= SUM(points for all 11 signs)

diagnostic index =

= SUM(points for all of the signs and symptoms)

Interpretation:

• minimum total score: -24

• maximum total score: 43

• The higher the score, the more likely thyrotoxicosis.

Total Score	Interpretation
<= 10	nontoxic
11 – 19	indeterminate
>= 20	toxic

Patients in whom the index may prevent diagnostic errors:

(1) post-menopausal women with menopausal symptoms

(2) normal young women with some symptoms suggesting thyrotoxicosis

(3) anxiety states

(4) thyrotoxic patients who are difficult to diagnose (multiple symptoms but few signs; typical features missing; atypical symptoms but many signs)

Performance:

• The index gave a good interobserver variability (see Table III, page 216).

• The index matched well with biochemical measures available at the time (basal metabolic rate, etc.)

To read more or access our algorithms and calculators, please log in or register.

Description

Specialty

Objective

ICD-10

Clinical Diagnostic Index of Crooks et al for Thyrotoxicosis

Purpose: To evaluate a patient for thyrotoxicosis using the clinical diagnostic index of Crooks et al.

Description

Specialty

Objective

ICD-10