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.)
Purpose: To evaluate a patient for thyrotoxicosis using the clinical diagnostic index of Crooks et al.
Specialty: Endocrinology, Clinical Laboratory
Objective: clinical diagnosis, including family history for genetics, criteria for diagnosis
ICD-10: E05,