Zulewski et al developed a clinical score for evaluating a patient for signs and symptoms of hypothyroidism. This can be used in conjunction with thyroid function laboratory tests to diagnose patients and to monitor response to therapy. The authors are from the University Hospital in Basel, Switzerland.
Score components:
(1) symptoms (7)
(2) physical signs (5)
|
Symptoms |
Finding |
Points |
|---|---|---|
|
diminished sweating (in a warm room or on a hot summer day) |
absent |
0 |
|
|
present |
1 |
|
hoarseness |
absent |
0 |
|
|
present |
1 |
|
paraesthesias |
absent |
0 |
|
|
present |
1 |
|
dry skin |
absent |
0 |
|
|
present |
1 |
|
constipation (bowel habits, need to use laxative) |
absent |
0 |
|
|
present |
1 |
|
impaired hearing |
absent |
0 |
|
|
present |
1 |
|
weight increase (recorded weight increase, tight clothing) |
absent |
0 |
|
|
present |
1 |
|
Physical Signs |
Finding |
Points |
|---|---|---|
|
slow movements |
absent |
0 |
|
|
present |
1 |
|
delayed ankle reflex (observe relaxation of the reflex) |
absent |
0 |
|
|
present |
1 |
|
coarse skin that is rough and thickened (over hands, forearms, elbows, other sites) |
absent |
0 |
|
|
present |
1 |
|
periorbital puffiness (curve of malar bone obscured) |
absent |
0 |
|
|
present |
1 |
|
cold skin |
absent |
0 |
|
|
present |
1 |
subscore for symptoms =
= SUM(points for all 7 symptoms)
subscore for physical signs =
= SUM(points for all 5 symptoms)
total score =
= (symptom subscore) + (physical signs score)
Interpretation:
• minimum score: 0
• maximum score: 12
|
Score |
Diagnosis |
|---|---|
|
> 5 |
hypothyroid |
|
3 – 5 |
indeterminate ("intermediate") |
|
< 3 |
euthyroid |
Performance:
• The cutoff scores for the score were set to provide > 90% positive and negative predictive values for hypothyroidism.
• The clinical score performed well in comparison with the Billewicz index (see below).
• The score shows good correlation with objective measures in patients with hypothyroidism (ankle reflex relaxation, serum total cholesterol, serum free T4).
Limitations:
• A score < 3 would also be seen with hyperthyroidism.
• The scoring is all or nothing for each symptom. It might be interesting to see a variation on the score to allow for mild to severe symptom severity.
Purpose: To evaluate a patient for clinical evidence of hypothyroidism using the clinical score of Zulewski et al.
Specialty: Endocrinology, Clinical Laboratory
Objective: criteria for diagnosis
ICD-10: E01, E02, E03,
