Does Subclinical Hypothyroidism Add Any Symptoms? Evidence from a Danish Population-Based Study

Allan Carlé*, Jesper Scott Karmisholt, Nils Knudsen, Hans Perrild, Bettina Heinsbæk Thuesen, Lars Ovesen, Lone Banke Rasmussen, Inge Bülow Pedersen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

5 Citations (Scopus)


BACKGROUND: Few studies have scrutinized the spectrum of symptoms in subclinical hypothyroidism.

METHODS: From 3 Danish Investigation on Iodine Intake and Thyroid Diseases (DanThyr) cross-sectional surveys performed in the period 1997 to 2005, a total of 8903 subjects participated in a comprehensive investigation including blood samples and questionnaires on previous diseases, smoking habits, alcohol intake, and education. From the 3 surveys we included patients with subclinical hypothyroidism (n = 376) and euthyroid controls (n = 7619). We explored to what extent patients with subclinical hypothyroidism reported 13 previously identified hypothyroidism-associated symptoms (tiredness, dry skin, mood lability, constipation, palpitations, restlessness, shortness of breath, wheezing, globus sensation, difficulty swallowing, hair loss, dizziness/vertigo, and anterior neck pain). In various uni- and multivariate regression models we searched for circumstances predicting why some patients have more complaints than others.

RESULTS: Subclinically hypothyroid patients did not report higher hypothyroidism score [(median, interquartile range), 2 (0-4) vs 2 (0-4), P = .25] compared with euthyroid controls. Within the group of subclinical hypothyroid patients, comorbidity had the highest impact on symptoms (tiredness, shortness of breath, wheezing; all P < .001); TSH level had no impact on symptom score; and younger age was accompanied by higher mental burden (tiredness, P < .001; mood lability, P < .001; restlessness, P = .012), whereas shortness of breath was associated with high body mass index (P < .001) and smoking (P = .007).

CONCLUSION: Patients with a thyroid function test suggesting subclinical hypothyroidism do not experience thyroid disease-related symptoms more often than euthyroid subjects. In subclinical hypothyroidism, clinicians should focus on concomitant diseases rather than expecting symptomatic relief following levothyroxine substitution.

Original languageEnglish
JournalAmerican Journal of Medicine
Issue number9
Pages (from-to)1115-1126.e1
Publication statusPublished - Sep 2021

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.


  • Case-control study
  • Hypothyroidism
  • Overt hypothyroidism
  • Population-based study
  • Subclinical hypothyroidism
  • Symptoms


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