Department of Medicine, Kirkuk General Hospital, Kirkuk, Iraq


Background: Thyrotoxicosis denotes thyroid hormone excess from any cause. Hyperthyroidism specifically refers to endogenous thyroid gland over-activity most commonly caused by grave′s disease, toxic multi-nodular goiter, or toxic adenoma. Signs and symptoms vary between people and during pregnancy. This study attempt to help our hyperthyroid patients to circumvent the cost of thyroid function tests, a relatively heavy financial burden for the average Iraqi citizen now a days, also when thyroid function tests results are at variance with clinical suspicion. Aim: To design a protocol for clinical diagnosis of hyperthyroidism utilizing the Wayne′s Thyrotoxicosis Diagnostic Index (WTDI) as a base line. Material and Methods: This study was conducted on 100 thyrotoxic patients diagnosed by hormonal assay and 100 clinically euthyroid subjects of similar sex and age, attending Kirkuk General Hospital and private clinic over a period of two years from June 2012 -- June 2014 .We took a history and physical examination pertinent to hyperthyroidism for each patient and each subject including all component of the WTDI .The main outcome measures obtained both patients and subjects measured using sensitivity, specificity ,and predictive values of each symptom and sign. The WTDI was utilized for assessing the clinical findings of patient and subject. Result: 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 diagnosis when absent. Both hot hands and tachycardia reached rule-in and rule -out states. 95 of the 100 patients entered the thyrotoxicosis zone of the WTDI by attaining more than or equal to 19 points. By offering two points and one point to the velvety skin and the wide pulse pressure respectively, all the 100 patients attained more than or equal to 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. Conclusions: WTDI with minor modification is worth adopting for diagnosing thyrotoxicosis and on follow up re-assessment of patient during medical treatment 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 elaborated evaluation.