Spectrum of clinical symptomatology and its resolution following levothyroxine supplementation in primary and subclinical hypothyroidism: An Indian perspective

Sachin Chittawar, Apeksha Nagdeote, Abhinav Nair, Krishna Kumar Kawre, Deep Dutta

Thyroid Research and Practice 2018 15(1):29-33

Background: Data are scant on the spectrum of features associated with subclinical hypothyroidism (ScH) and overt primary hypothyroidism (OPH). This study aimed was to determine the burden as well as predictors of the lack of resolution of symptoms of hypothyroidism in patients of ScH and OPH following levothyroxine supplementation. Methods: A total of 505 patients were screened, of which 411 consecutive patients with ScH and 94 with OPH were evaluated. Data from 347 patients with ScH and 76 patients with overt OPH, who completed the study, were analyzed. Thyroid symptomatology was evaluated using standardized questionnaire. Results: The median age of participants was 35 (28–41) years; 95.04% being females. Common symptoms in OPH were shortness of breath (72.36%), depression (57.89%), irritability (57.89%), periorbital edema (53.94%), "feeling tired" (51.31%), and swelling of limbs (48.68%). Common symptoms in ScH were "feeling tired" (62.82%), "unhappy with routine" (44.95%), depression (40.92%), irritability (38.90%), and "weight gain with a poor appetite" (36.31%). Goiter was documented in 31.58% OPH and 3.17% in ScH (P < 0.001). Hair loss was observed 31.57% OPH and 29.68% ScH. Median (interquartile range) dose of levothyroxine supplemented was 37.5 (12.5–50) and 100 (75–112.5) mcg, respectively. Resolution of hypothyroidism symptoms was lesser in ScH. Persisting features included goiter, irregular menstruation, "weight gain with poor appetite," irritability, depression, "feeling tired," body aches, and depression. Binary logistic regression revealed thyroid stimulating hormone (TSH) to be an independent predictor of symptoms resolution. Every unit increase in TSH was associated with 0.7% greater resolution. Conclusion: Symptoms associated with hypothyroidism are diverse and nonspecific. Resolution of symptoms following levothyroxine supplementation and achieving biochemical euthyroidism is more likely in OPH that ScH.

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