Thyroid symptom scoring index: an auxiliary guide to thyroid function tests: a prospective comparative study from a general hospital in South India


  • Zahir S. Hussain Department of Endocrine Surgery, Madras medical college, Chennai, Tamil Nadu, India
  • Smitha S. Rao Department of Endocrine Surgery, Madras medical college, Chennai, Tamil Nadu, India
  • Ferdinant Jabamalai Department of Endocrine Surgery, Madras medical college, Chennai, Tamil Nadu, India



Thyroid symptom scoring index, TFT, FT4


Background: Thyroid disease has myriad manifestations. Thyroid stimulating hormone (TSH) and a paired determination of TSH and freeT4 would add to find out the degree of dysfunction with overutilization of thyroid function tests (TFT’s) as the symptoms are being overseen in the recent days. The objectives of the present study were to validate the clinical symptom scoring index for thyroid disorders using TSH and FT4.

Methods: The clinical symptom scoring index consisting of 20 parameters was given to 110 patients presenting to our outpatient department with new onset thyroid-related complaints from June2018 to Spetemer2018. They were subjected to TFT (TSH and free T4) and classified accordingly. Statistical analysis was done and receiver operator curves (ROC) plotted.

Results: The mean TSH for the 3 groups (hypothyroid, hyperthyroid and euthyroid) were 13.65, 0.31 and 1.7 mIu/ml respectively (normal value: NV-0.25-5). Mean FT4 were 0.58, 5.01 and 1.28 ng/dl respectively (normal value 0.82-1.51). Most frequent findings in biochemical hyperthyroidism were easy tremors (100%), tiredness (90%), palpitations (93%) and weight loss (75.6%). The clinical symptom scoring index had a sensitivity of 85% and accuracy rate of 86.76% with area under the curve (AUC) 0.865 on ROC analysis for the detection of hyperthyroidism. It had a 100% sensitivity and AUC 0.65 for hypothyroidism.

Conclusions: The symptom scoring index for thyroid disorders was found to have good specificity, negative predictive value (NPV) and accuracy rate when correlated with TSH and FT4 for the detection of hyperthyroidism. In the developing countries, these score indices can aid as auxiliary diagnostic tools, reducing the load on referral centers. 


Galia AM, Andag-Silva AA, Kho SA, Luis TOS. Magboo-Gaviola L. Validation of the UST thyroid scoring index against ultrasensitive assays for thyroid-stimulating hormone and free thyroxine. Philippine J Internal Med. 2010;48(1):15-23.

Nazarpour S, Tehrani RF, Rahmati M, Minooee S, Simbar M, Noroozzadeh M, et al. Validation of Billewicz scoring system for detection of overt hypothyroidism during pregnancy. Int J Endocrinol Metab. 2018:16(3);e64249.

Canaris GJ, Steiner JF, Ridgway EC. Do traditional symptoms of hypothyroidism correlate with biochemical disease?. J Gen Intern Med. 1997;12(9):544-50.

Lee J, Lee DH, Oh TJ, Kim KM, Choi SH, Lim S, et al. Korean version of hyperthroidism symptom scale Endocrinol Metab. 2018; 33:70-8.

Schneider C, Feller M, Bauer DC, Collet TH, da Costa BR, Auer R, et al. Initial evaluation of thyroid dysfunction - Are simultaneous TSH and fT4 tests necessary?. Plos One. 2018;13(4):e0196631.

Caceres R, Yabon-Velasco R, Magboo ML, San Luis T. Clinical Scoring in the assessment of thyroid function: a University of Santo Tomas Hospital Experience. Philippine J Internal Med. 1993;31:253:3-5.

Biondi B, Cooper D. The clinical significance of subclinical thyroid dysfunction. Endocrine Reviews. 2008;29(1):76.

Wayne EJ. Clinical and metabolic studies in thyroid disease. Br Med J. 1960:1(5166):78–90.

Devereaux D, Tewelde SZ. Hyperthyroidism and thyrotoxi¬cosis. Emerg Med Clin North Am. 2014;32:277-92.

De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016;388:906-18.

Smith TJ, Hegedus L. Graves’ disease. N Engl J Med. 2016;375:1552-65.

Carney LA, Quinlan JD, West JM. Thyroid disease in pregnancy. Am Fam Physician. 2014;89(4):273–8.

LeFevre ML, Force USPST. Screening for thyroid dysfunction: U.S. Preventive Services Task Force recommendation statement. Ann Internal Med. 2015;162(9):641-50.

Viera AJ. Thyroid function testing in outpatients: are both sensitive thyrotropin (sTSH) and free thyroxine (FT4) necessary?. Fam Med. 2003;35(6):408-10.

Surks MI, Chopra IJ, Mariash CN, Nicoloff JT, Solomon DH. American thyroid association guidelines for use of laboratory tests in thyroid disorders. JAMA. 1990;263(11):1529-32.






Original Research Articles