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Hyperthyroidism: Likelihood Ratios

Introduction: Hyperthyroidism is often caused by Graves disease, with activating antibodies against the TSH receptor.

Note that signs and symptoms of hyperthyroidism differ based on the age of the patient population, with older patients presenting more as apathetic hyperthyroidism (more apathy, anorexia) versus the typical diarrhea / tremor / nervousness / heat intolerance of younger patients. Older patients are more likely to be confused and much more likely to manifest atrial fibrillation.

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Tags: Endocrine Tag this Diagnosis.

Prevalence

Population / CalculatorPrevalence Comments / Study / Link
Older US adults 2% 2% overall, 0.7% excluding iatrogenic cases

J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Hospitalized inpatients with atrial fibrillation 1% Another study found prevalence of 5%, though with only 6 weeks of follow-up.

Arch Intern Med. 1999 Apr 12;159(7):658-65. PMID: 10218744

Hospitalized inpatients 1% Note that many hospitalized patients are transiently hypo/hyper-thyroid! Biggest offender is glucocorticoids, according to the paper.

Arch Intern Med. 1999 Apr 12;159(7):658-65. PMID: 10218744

More, Edit...

The likelihood ratios of findings for Hyperthyroidism are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding +LR-LR Comments, Study
TSH Edit 13.10.1

exact sens / spec depends on the particular TSH assay used

Study: Arch Intern Med 1989 Mar;149(3):526-32. PMID 2493228

Free T4
Duplicate Edit
13.70.2

estimated

Study: Arch Intern Med 1989 Mar;149(3):526-32. PMID 2493228

Free T4
Duplicate Edit
11.10.2

calculated

Study: Arch Intern Med 1989 Mar;149(3):526-32. PMID 2493228

Free T3 Edit 7.20.2

Study: Arch Intern Med 1989 Mar;149(3):526-32. PMID 2493228

Tachycardia Edit 2.50.4

patients > 70

sensitivity for age < 50 is 96%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Good Positive Likelihood Ratio

Finding +LR-LR Comments, Study
Nervousness Edit inf0.7

age > 70

sensitivity in age < 50 is 84%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Hyperreflexia Edit inf0.7

age > 70

sensitivity in age < 50 is 96%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Increased Sweating Edit inf0.8

age > 70

sensitivity in age < 50 is 95%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Polydipsia Edit inf0.8

age > 70

sensitivity in age < 50 is 67%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Muscular Atrophy Edit inf0.8

age > 70

sensitivity in age < 50 is 10%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Heat intolerance Edit inf0.9

age > 70

sensitivity in age < 50 is 92%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Apathy Edit 10.30.6

age > 70

sensitivity in age < 50 is only 25%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Confusion Edit 80.9

age > 70

sensitivity in age < 50 is 0%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Diarrhea Edit 60.8

age > 70

sensitivity in age < 50 is 43%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Weight loss Edit 50.6

patients > 70

sensitivity for age < 50 is similar

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Weakness Edit 4.50.8

age > 70

sensitivity in age < 50 is 61%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Anorexia Edit 3.60.7

age > 70

sensitivity in age < 50 is only 4%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Dyspnea Edit 2.70.7

age > 70

sensitivity for age <50 is 56%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Poorly Diagnostic Findings

Finding +LR-LR Comments, Study
Constipation Edit 1.31

age > 70

sensitivity in age < 50 is 0%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Depression Edit 1.60.9

age > 70

sensitivity in age < 50 is similar

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Tremor Edit 1.40.8

age > 70

sensitivity in age < 50 is 84%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Fatigue Edit 1.80.6

patients > 70

sensitivity for age < 50 is 84%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Increased Appetite Edit Sensitivity = 57%

age < 50

sensitivity in age >70 is 0%!

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Goiter Edit Sensitivity = 50%

age > 70

sensitivity in patients < 50 is 94%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Atrial Fibrillation Edit Sensitivity = 35%

age > 70

sensitivity in age < 50 is only 2%

Study: J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Findings With Unspecified Accuracy

Finding +LR-LR Comments, Study
Palpitations Edit No accuracy specified.

Study: no study specified.