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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 1  |  Issue : 3  |  Page : 142-144

Correlation between wayne's score and laboratory evidence of thyrotoxicosis in Nigeria


1 Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
3 Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
4 Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Submission01-Apr-2014
Date of Acceptance24-May-2014
Date of Web Publication17-Aug-2014

Correspondence Address:
Anas Ahmad Sabir
Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Nigeria
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DOI: 10.4103/2384-5147.138944

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  Abstract 

Background: The diagnosis of thyrotoxicosis is based on clinical suspicion and confirmed by thyroid function test. In Nigeria, measurements of thyroid function tests are not readily available therefore the need for clinical assessment remains paramount in the diagnosis and management of thyrotoxicosis. Objective: The objective was to determine the relationship between Wayne's score and biochemical indices of thyroid function in Nigerians. Materials and Methods: A total of 30 newly diagnosed patients with thyrotoxicosis referred to the Endocrinology Clinic were recruited for participation in this study. All patients had detailed history taken and thorough physical examinations performed. They were also assessed using the Wayne's score. The patients also had the biochemical evaluation of their thyroid function. The relationship between the Wayne's score values and the biochemical indices were then correlated using the Pearson's correlation coefficient. Results: All the patients with elevated thyroid hormones had elevated Wayne's score. The correlation coefficient between T3 and Wayne's score was 0.79, whereas between T4 and Wayne's score was 0.81. The average Wayne's score was 31.6. There was negative correlation between age and Wayne's score (r = 0.86). Conclusion: The Wayne's score can be used as a screening tool for thyrotoxicosis in our environment.

Keywords: Thyroid hormones, thyrotoxicosis, Wayne′s score


How to cite this article:
Sabir AA, Iwuala SO, Fasanmade OA, Abubakar SA, Haruna GY, Ohwovoriole AE. Correlation between wayne's score and laboratory evidence of thyrotoxicosis in Nigeria. Sub-Saharan Afr J Med 2014;1:142-4

How to cite this URL:
Sabir AA, Iwuala SO, Fasanmade OA, Abubakar SA, Haruna GY, Ohwovoriole AE. Correlation between wayne's score and laboratory evidence of thyrotoxicosis in Nigeria. Sub-Saharan Afr J Med [serial online] 2014 [cited 2019 May 20];1:142-4. Available from: http://www.ssajm.org/text.asp?2014/1/3/142/138944


  Introduction Top


Thyrotoxicosis is a relatively common disorder. It occurs in all parts of the world, affecting 2% of women and 0.2% of males. [1] It is a clinical syndrome due to excessive amounts of thyroid hormone in the circulation and its excessive effects on tissues. The diagnosis is based on clinical suspicion and confirmed by thyroid function test. [2] In Nigeria, measurements of thyroid function test such as serum thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3) are not readily available and even when available they are quite expensive with associated delay before the result is obtained. Therefore, the need for clinical assessment remains paramount in the diagnosis and management of thyrotoxicosis.

The Wayne's score is a clinical score that may be used in the clinical diagnosis of thyrotoxicosis. [3] It is a diagnostic index that scores the presence or absence of various signs and symptoms of hyperthyroidism for the purpose of establishing a diagnosis.

The objective was to determine the relationship between Wayne's score and biochemical indices of thyroid function in Nigerians.


  Materials and Methods Top


A total of 30 newly diagnosed patients with thyrotoxicosis referred to the Endocrinology Clinic of the Lagos University Teaching Hospital were recruited for participation in this study. All subjects gave informed consent.

All patients had detailed history taken and thorough physical examination performed. All the patients were also evaluated using the Wayne's score which is a scoring scale that rates dyspnea on exertion, palpitation, tiredness, heat intolerance, cold intolerance, nervousness, excessive sweating, appetite, weight, palpable thyroid, bruit, exophthalmos, lid retraction, lid lag, hyperkinesia, hands, and atrial fibrillation [Table 1]. Wayne's score of >19 is considered diagnostic of thyrotoxicosis, 11-19 is considered equivocal and <11 is considered euthyroid. [3]
Table 1: Wayne's score for the diagnosis of hyperthyroidism


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The patients also had the biochemical evaluation of their thyroid function-T3, T4, TSH done using enzyme-linked immunosorbent assay. The relationship between the Wayne's score values and the biochemical indices were then correlated using the Pearson's correlation coefficient. Patients with cardiac diseases or already on anti-thyroid medications were excluded from the study.


  Results Top


Twenty-one (70%) subjects were females, while nine (30%) subjects were males. The patients' ages ranged between 19 and 61 years with a mean age of 33.3 ± 8.6 years. The highest frequency of thyrotoxicosis (36.7%) was in the age group 25-34 years as shown in [Table 2].
Table 2: Distribution of thyrotoxicosis patients by age group


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All the patients with elevated thyroid hormones had elevated Wayne's score >19. The correlation coefficient between T3 and Wayne's score was 0.79, while between T4 and Wayne's score was 0.81. The average Wayne's score was 31.6. There was negative correlation between age and Wayne's score (r = −0.86). The relationship between thyroid hormones and Wayne's score is illustrated in [Table 3].
Table 3: Relationship between thyroid hormones and Wayne's score


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  Discussion Top


We found that thyrotoxicosis was more common in the females affecting the young adult population more than the elderly. This is similar to other studies that found thyrotoxicosis to be more common in young females. [1],[4],[5] The negative correlation between age and Wayne's score suggests that old age is associated with clinically less severe thyrotoxicosis and the diagnosis of thyrotoxicosis may be more difficult in the elderly. This is in keeping with other findings. [6],[7],[8] The exact reason for less severe clinical features in older age groups remains incompletely understood. [7] However reduced production of thyroid hormones with advancing age has been suggested the so called "thyroid hormone economy". [9] Clinically less severe thyrotoxicosis in the older age group can also be as a result of masking of clinical features by coexisting diseases or the treatment (e.g., beta blockers used in the treatment of hypertension can mask tachycardia and tremors found in thyrotoxicosis).

We found out that all the patients with elevated thyroid hormones had elevated Wayne's score and therefore it can be used for screening thyrotoxicosis. This finding was also previously found by other researchers. [3],[10],[11],[12],[13]

The Wayne's score correlated well with the biochemical indices of thyrotoxicosis.

While our research and some previous research works [8] found strong correlation between the severity of thyrotoxic symptoms and elevation in the serum levels of free T4 and T3 estimates, other studies found no strong correlation. [11],[12] Trzepacz et al. [11] found out that the hyperthyroid symptom scale did not strongly correlate with free T4 or T3 estimates and was inversely correlated with age. Kolawole et al. [12] also found elevated Wayne's score in all patients with biochemical evidence of thyrotoxicosis. However, they found no correlation between symptoms severity and hormones levels, which may be due to the individual variations in the sensitivity of thyroid hormone receptors to thyroid receptors.

Differences in previous findings may be due to methodological differences such as different criteria for patient inclusion, observer error (because some observers tended to score consistently lower than others) or early diagnosis of thyrotoxicosis at a less advanced stage.

The Limitation of the Study

Being an open un-blinded design there is possibility of bias.


  Conclusion Top


The Wayne's score which is an observer - rated and easy to administer clinical assessment tool correlated well with the biochemical indices of thyrotoxicosis. It can therefore be used as a screening tool for thyrotoxicosis in our environment. However, larger studies need to be carried out.

 
  References Top

1.Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull 2011;99:39-51.  Back to cited text no. 1
[PUBMED]    
2.Pearce EN. Diagnosis and management of thyrotoxicosis. BMJ 2006;332:1369-73.  Back to cited text no. 2
[PUBMED]    
3.Crooks J, Murray IP, Wayne EJ. Statistical methods applied to the clinical diagnosis of thyrotoxicosis. Q J Med 1959;28:211-34.  Back to cited text no. 3
[PUBMED]    
4.Hassan F. Goiter and thyrotoxicosis in sulaimani. J Zankoy Sulaimani 2001;4:45-53.  Back to cited text no. 4
    
5.Vadiveloo T, Donnan PT, Cochrane L, Leese GP. The thyroid epidemiology, audit, and research study (TEARS): The natural history of endogenous subclinical hyperthyroidism. J Clin Endocrinol Metab 2011;96:E1-8.  Back to cited text no. 5
    
6.Rehman SU, Cope DW, Senseney AD, Brzezinski W. Thyroid disorders in elderly patients. South Med J 2005;98:543-9.  Back to cited text no. 6
    
7.Boelaert K, Torlinska B, Holder RL, Franklyn JA. Older subjects with hyperthyroidism present with a paucity of symptoms and signs: A large cross-sectional study. J Clin Endocrinol Metab 2010;95:2715-26.  Back to cited text no. 7
    
8.Bhattacharyya A, Wiles PG. Thyrotoxicosis in old age: A different clinical entity? Hosp Med 1999;60:115-8.  Back to cited text no. 8
    
9.Mooradian AD. Asymptomatic hyperthyroidism in older adults: Is it a distinct clinical and laboratory entity? Drugs Aging 2008;25:371-80.  Back to cited text no. 9
[PUBMED]    
10.Harvey RF. Indices of thyroid function in thyrotoxicosis. Lancet 1971;2:230-3.  Back to cited text no. 10
[PUBMED]    
11.Trzepacz PT, Klein I, Roberts M, Greenhouse J, Levey GS. Graves' disease: An analysis of thyroid hormone levels and hyperthyroid signs and symptoms. Am J Med 1989;87:558-61.  Back to cited text no. 11
    
12.Kolawole BA, Ikem RT, Lawal OO. Relationship between thyroid hormone levels and hyperthyroid signs and symptoms. Niger J Clin Pract 2002;5:29-31.  Back to cited text no. 12
    
13.Ibrahim NA, Atoyebi OA, Atimomo CE, Da Rocha AJ. An evaluation of the cost-effectiveness of thyroid function tests in the management of goitres. Nig Q J Hosp Med 1997;7:62-5.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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