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Gay J. Canaris, MD, MSPH; Neil R. Manowitz, PhD; Gilbert Mayor, MD; E. Chester Ridgway, MD

Arch Intern Med. 2000;160:526-534.

Context  The prevalence of abnormal thyroid function in the United States and the significance of thyroid dysfunction remain controversial. Systemic effects of abnormal thyroid function have not been fully delineated, particularly in cases of mild thyroid failure. Also, the relationship between traditional hypothyroid symptoms and biochemical thyroid function is unclear.

Objective  To determine the prevalence of abnormal thyroid function and the relationship between (1) abnormal thyroid function and lipid levels and (2) abnormal thyroid function and symptoms using modern and sensitive thyroid tests.

Design  Cross-sectional study.

Participants  Participants in a statewide health fair in Colorado, 1995 (N = 25,862).

Main Outcome Measures  Serum thyrotropin (thyroid-stimulating hormone [TSH]) and total thyroxine (T₄) concentrations, serum lipid levels, and responses to a hypothyroid symptoms questionnaire.

Results  The prevalence of elevated TSH levels (normal range, 0.3-5.1 mIU/L) in this population was 9.5%, and the prevalence of decreased TSH levels was 2.2%. Forty percent of patients taking thyroid medications had abnormal TSH levels. Lipid levels increased in a graded fashion as thyroid function declined. Also, the mean total cholesterol and low-density lipoprotein cholesterol levels of subjects with TSH values between 5.1 and 10 mIU/L were significantly greater than the corresponding mean lipid levels in euthyroid subjects. Symptoms were reported more often in hypothyroid vs euthyroid individuals, but individual symptom sensitivities were low.

Conclusions  The prevalence of abnormal biochemical thyroid function reported here is substantial and confirms previous reports in smaller populations. Among patients taking thyroid medication, only 60% were within the normal range of TSH. Modest elevations of TSH corresponded to changes in lipid levels that may affect cardiovascular health. Individual symptoms were not very sensitive, but patients who report multiple thyroid symptoms warrant serum thyroid testing. These results confirm that thyroid dysfunction is common, may often go undetected, and may be associated with adverse health outcomes that can be avoided by serum TSH measurement.

From the Division of General Internal Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha (Dr Canaris); Knoll Pharmaceutical Co, Mt Olive, NJ (Drs Manowitz and Mayor); and the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Health Science Center, Denver (Dr Ridgway). Dr Mayor is currently with the Mayor Group LLC, Morristown, NJ.

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