Endocrine Abstracts

Background: Clinical scoring systems were used traditionally in the diagnosis of hypothyroidism before biochemical diagnosis became the norm. There are two well validated clinical scoring systems (Billewicz and Zulewski) for diagnosing hypothyroidism. Both these scores were validated in younger patients with hypothyroidism and may not be useful in older patients. We conducted this study to determine the clinical utility of these two scoring systems among patients over the age of 60 years for diagnosing hypothyroidism.

Aims and objectives: To determine the sensitivity and specificity of the Billewicz diagnostic index and Zulewski clinical score in diagnosing hypothyroidism in elderly subjects suspected to have hypothyroidism.

Materials and methods: This observational study was conducted in the Departments of Medicine and Endocrinology at tertiary care university affiliated teaching hospital from December 2017 to September 2019. After informed consent, clinical data and scoring of the patients was collected in elderly subjects (n = 200) with suspected hypothyroidism. A biochemical diagnosis of primary hypothyroidism was considered the gold standard (raised TSH levels with a low FT4 levels).

Results: Billewicz score was 99.32% specific and 1.85% sensitive, while specificity and sensitivity of Zulewski score was 80.82% and 37.04% respectively (considering indeterminate scores as euthyroid). After considering Indeterminate as hypothyroid, sensitivity of Billewicz and Zulewski score was 75.93% and 70.37%; and specificity was 20.55% and 36.99% respectively. Only the Zulewski score (indeterminate as euthyroid) showed weak significant agreement with final diagnosis of hypothyroidism (K = 0.185, P = 0.009).

Conclusion: Both scoring systems do not help in the diagnosis of hypothyroidism among elderly patients.

Keywords: thyroid gland, hypothyroidism, billewicz diagnostic index, zulewski clinical score, indeterminate.