RESUMEN
Rationale: An attempt to help hyperthyroid patients to circumvent the cost of thyroid function tests, a relatively heavy financial burden for the average Iraqi citizen nowadays. To design a protocol for clinical diagnosis of hyperthyroidism utilizing the Wayne's Thyrotoxicosis Diagnostic Index [WTDI] as a base line. Design: Clinical comparison of hyperthyroid patients and euthyroid subjects. Setting: a. for patients, Hazim-Al-Hafidh Oncology and Nuclear Medicine Hospital, Mosul, b. for subjects, visitors of Ibn Seena Teaching Hospital, Mosul. The study was conducted during the period from December 1997 to August 1998. Participants: One hundred thyrotoxic patients diagnosed by hormonal assays and one hundred clinically euthyroid subjects of similar sex and age. Intervention: History and physical examination pertinent to hyperthyroidism for each patient and each subject including all components of the WTDI. Main outcome measures: Clinical data obtained from both patients and subjects were measured using sensitivity, specificity, and predictive values of each symptom and sign. The WTDI was utilized for assessing the clinical findings of each patient and subject Two symptoms and ten physical signs, including two new signs that were not part of WTDI - the velvety skin and the wide pulse pressure, attained confirmatory value in ruling - in the diagnosis of hyperthyroidism. Two symptoms and four signs did attain a confirmatory value in ruling - out the diagnosis when absent. Both hot hands and tachycardia reached rule - In and rule - out states. Ninety-five of the one hundred patients entered the thyrotoxicosis zone of the WTDI by attaining >/= 19 points. By offering two points and one point to the velvety skin and the wide pulse pressure respectively, all the 100 patients attained >/= 19 points. The highest score attained by any of the 100 subjects was 14 points; the mentioned addition would at most bring the highest score among subjects to 17 points; less than the diagnostic score of WTDI. Heat intolerance did not reach a ruling - in or ruling - out diagnostic value in our study though given the highest diagnostic value in WTDI. The reason[s] for such discrepancy was discussed. Koilonychia was noted in 29% of the patients and 8% of the subjects. WTDI with minor modification is worth to be adopted for the diagnosis of thyrotoxicosis and for follow up reassessment of patients during medical treatment particularly when a patient could not bear the cost of the thyroid function tests with the possible exception of some patients like pregnant women who may need a more elaborate evaluation