Physical Examination or Test Results: Which More Accurately Diagnoses Hypothyroidism?

Indian researchers looked at the accuracy of various physican signs of hypothyroidism -- coarse skin, puffy face, slow movements, slow heartrate, slow ankle reflex -- versus blood testing for TSH and Free T4. What the researchers discovered was that of 1450 patients screened, 130 patients (102 women and 28 men) underwent both clinical examination and thyroid function tests. Twenty-three patients were diagnosed to have hypothyroidism by thyroid hormone assays. What they found was that no single sign could easily discriminate someone with normal thyroid levels from a hypothyroid patient. No particular physical sign made it likely enough to increase the accuracy. The combination of signs that had the highest likelihood ratios (coarse skin, slow heart rate and delayed ankle reflex) was associated with modest accuracy. This led researchers to conclude that practitioners cannot rely solely on physical examination to confirm or rule out hypothyroidism, and patients who are suspected of being hypothyroid should also have a diagnostic workup that includes thyroid hormone blood tests.

Note from Mary: Keep in mind, some practitioners believe that blood tests are not an accurate way to diagnose hypothyroidism in all patients, and that symptoms, clinical signs, and family history should all be considered when making a diagnosis.

Source: Indra R, et. al. Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study, J Postgrad Med. 2004 Jan-Mar;50(1):7-11; discussion 11