Study on Billewicz Clinical Scoring Index for Diagnosis of Patients with Symptoms of Hypothyroidism.

Abstract

Background: Thyroid disease encompasses a broad range of clinical manifestations. Thyroid Stimulating Hormone (TSH) testing is widely regarded as the most effective method for detecting thyroid dysfunction. In primary care settings where thyroid function tests are often unavailable, symptom-based scoring indexes (Wayne’s index for hyperthyroidism and the Billewicz Clinical Scoring Index (BCSI) for hypothyroidism) can be valuable in predicting thyroid dysfunction, potentially reducing unnecessary testing. Objective: To evaluate the efficacy of the Billewicz Clinical Scoring Index in diagnosing hypothyroidism. Methods: This hospital-based, cross-sectional study involved 191 patients aged 18 years and older with symptoms suggestive of hypothyroidism, who attended the General Medicine outpatient department at Aarupadai Veedu Medical College and Hospital. Exclusion criteria included critically ill patients and those already receiving thyroid medication. Patients were evaluated using the BCSI, followed by thyroid function testing (Free T3, Free T4, and TSH). Data were analyzed using SPSS version 23.0. Results: The BCSI predicted hypothyroidism in 43.45% of patients, subclinical hypothyroidism in 22.5%, and normal thyroid function in 34%. Laboratory results confirmed hypothyroidism in 30.4% of patients, subclinical hypothyroidism in 44.0%, and euthyroid status in 25.7%. There was significant concordance between BCSI predictions and laboratory findings, with 69.8% of BCSI-predicted hypothyroid cases confirmed by laboratory tests, while 31.32% were identified as subclinical hypothyroidism. Among patients predicted to be euthyroid by BCSI, 1.53% were found to have hypothyroidism and 23.07% had subclinical hypothyroidism. The BCSI demonstrated a sensitivity of 98.3%, specificity of 80.5%, positive predictive value of 68.7%, negative predictive value of 99.1%, and an overall accuracy of 85.9%. Conclusion: The Billewicz Clinical Scoring Index is a reliable, cost-effective tool for the preliminary assessment of hypothyroidism in primary care settings. Its strong concordance with laboratory diagnostics underscores its utility in screening and guiding further diagnostic and management decisions.