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Hyperthyroidism: Sensitivity and Specificity

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 sensitivity and specificity of findings for Hyperthyroidism are listed below. See the left navigation bar to change the display.

Electronic Monitor

Finding SensitivitySpecificity Comments, Study
Tachycardia Edit 71%72%

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

History

Finding SensitivitySpecificity Comments, Study
Anorexia Edit 32%91%

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 41%85%

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

Physical Exam

Finding SensitivitySpecificity Comments, Study
Tachycardia Edit 71%72%

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

Weakness Edit 27%94%

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

Vital Signs

Finding SensitivitySpecificity Comments, Study
Tachycardia Edit 71%72%

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

Untagged

Finding SensitivitySpecificity Comments, Study
Apathy Edit 41%96%

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

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

Confusion Edit 16%98%

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

Constipation Edit 15%88%

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 24%85%

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

Diarrhea Edit 18%97%

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

Fatigue Edit 56%68%

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

Free T3 Edit 86%88%

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

Free T4
Duplicate Edit
82%94%

estimated

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

Free T4
Duplicate Edit
78%93%

calculated

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

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

Heat intolerance Edit 15%100%

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

Hyperreflexia Edit 28%100%

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 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

Increased Sweating Edit 24%100%

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

Muscular Atrophy Edit 16%100%

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

Nervousness Edit 31%100%

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

Palpitations Edit No accuracy specified.

Study: no study specified.

Polydipsia Edit 21%100%

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

Tremor Edit 44%69%

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

TSH Edit 92%93%

exact sens / spec depends on the particular TSH assay used

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

Weight loss Edit 50%90%

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