Wikipedia:Peer review/Hypothyroidism/archive1

Hypothyroidism

This peer review discussion has been closed.
I've listed this article for peer review because I am working on getting it to GA status and need feedback to make any necessary improvements. Constructive criticism and suggestions are welcomed.

Thanks, TylerDurden8823 (talk) 13:08, 18 December 2013 (UTC)

• From the lead section, paragraph 2: "Hypothyroidism has numerous causes such as... autoimmune disease." The preceding sentence already mentioned Hashimoto's disease. Are there other autoimmune diseases that cause hypothyroidism? Axl ¤ [Talk] 14:36, 18 December 2013 (UTC)

I'm sure it does have other autoimmune causes. I will look into it and have other autoimmune diseases used as examples so the article is not repetitive and harping on the Hashimoto's point. TylerDurden8823 (talk) 08:25, 19 December 2013 (UTC)

The general understanding is that there are two forms of autoimmune thyroiditis: with goitre is Hashimoto's disease, without goitre is atrophic thyroiditis. However that view is under debate. Axl ¤ [Talk] 11:01, 19 December 2013 (UTC)

• From "Signs and symptoms": " Numerous signs and symptoms are associated with hypothyroidism, and can relate to the underlying pathological cause of the hypothyroidism, a mass effect of a thyroid goiter, or direct effects of having insufficient thyroid hormones." However the list only includes features due to low T3/T4. Perhaps clarify that the list only includes that group? Axl ¤ [Talk] 14:50, 18 December 2013 (UTC)

We can just find signs/symptoms caused by the mass effect of a thyroid goiter and add those on to the list to make it more comprehensive.

You could do that, but I don't think that is a good approach. Currently, the section is an amalgamation of information from nine different sources. I think that readers are better served by a table of features all sourced from one single reference such as an authoritative endocrinology textbook. This also helps to ensure appropriate weighting, discourages point-of-view pushers, and avoids inappropriate sources ("Hormonal causes of male sexual dysfunctions and their management", "Characteristics of anemia in subclinical and overt hypothyroid patients", "When to consider thyroid dysfunction in the neurology clinic", "Evaluation and management of galactorrhea", "The renal manifestations of thyroid disease"). Axl ¤ [Talk] 11:20, 19 December 2013 (UTC)

I'd like more opinions on that. I don't see how these are inappropriate sources though the table idea is a good one. If you know how to format it, have at it. TylerDurden8823 (talk) 02:50, 20 December 2013 (UTC)

This article is about "Hypothyroidism". Its references should be generically about hypothyroidism, not focussed on specific aspects, especially in the "Signs and symptoms" section. This prevents issues of undue weighting. For example, the first source would be suitable for an article about hormonal abnormalities in erectile dysfunction, not for an article on hypothyroidism. The second source would be suitable for an article about anaemia in hypothyroidism. Wikipedia's article on "Hypothyroidism" is supposed to be a general encyclopedic article, not an exhaustive treatise on all aspects of hypothyroidism.

With endocrinology textbooks or review articles about hypothyroidism, the author/editor is an expert and has already decided on appropriate weighting for the various causes. Different sources may have discrepancies between the exact list, so it may be necessary to choose a source that you think best reflects the literature. Axl ¤ [Talk] 12:09, 20 December 2013 (UTC)

• From "Signs and symptoms": "Neurological:... rapid thoughts." I was surprised to see that, so I checked the reference. Indeed the reference focuses on subclinical hyperthyroidism. Axl ¤ [Talk] 15:07, 18 December 2013 (UTC)

So, that's an error made by the person who put rapid thoughts in? If so, I'll remove it. TylerDurden8823 (talk) 08:23, 19 December 2013 (UTC)

The source itself is inappropriate for this article. Axl ¤ [Talk] 11:21, 19 December 2013 (UTC)

Agreed, I'll think about how to best deal with this particular issue in the article. TylerDurden8823 (talk) 02:50, 20 December 2013 (UTC)

• From "Signs and symptoms": "Neurological:... deepening of the voice due to Reinke's edema." I don't think that a deep voice due to Reinke's edema is a neurological feature. Axl ¤ [Talk] 22:06, 18 December 2013 (UTC)

Fixed the Reinke's edema bit, good catch on that one, I hadn't noticed it was erroneously categorized under neurological. TylerDurden8823 (talk) 08:23, 19 December 2013 (UTC)

As I implied above, the whole section needs to be re-written. Axl ¤ [Talk] 11:22, 19 December 2013 (UTC)

Rewritten in what way? In prose format? You suggested a table before and I see you suggested doing it from one single authoritative source such as an endocrinology textbook (I don't own any), so if you have access to such a source, feel free to rearrange as you see fit. I think it's best to have a variety of sources since I doubt any one particular source will list off all of the numerous signs/symptoms of hypothyroidism-most review articles didn't have them all and omitted some well-known ones. TylerDurden8823 (talk) 02:50, 20 December 2013 (UTC)

Re-written as a table drawn from a single authoritative source. I shall have a look at some sources. Axl ¤ [Talk] 12:10, 20 December 2013 (UTC)

I have access to Williams Textbook of Endocrinology 12th edition. It has an excellent table of causes. However the clinical findings are described in text form. Axl ¤ [Talk] 22:47, 20 December 2013 (UTC)

Sounds perfect, I'll leave it to you to rearrange that section to reflect William's. TylerDurden8823 (talk) 07:27, 21 December 2013 (UTC)

lol, it's certainly not perfect. I'll probably look to use a different source for a table of signs of symptoms. Axl ¤ [Talk] 09:36, 21 December 2013 (UTC)

Harrison's Principles of Internal Medicine (18th edition) has a suitable table of clinical features. (I should have checked that book sooner.) Axl ¤ [Talk] 11:02, 22 December 2013 (UTC)

I've got the 17th, so let me know when you're ready to make the table and I'll work on it with you. The 17th has a table (probably the same or similar) listing signs/symptoms in descending order of frequency. I cleaned up that section a little bit (not in a table yet) and reordered things to some extent based on Harrison's descending frequency table. TylerDurden8823 (talk) 05:25, 23 December 2013 (UTC)

Axl this sentence goes on forever; by the time I get to the end of all of those clauses, I forget what it's trying to say. Are you able to fix it? I tried, and the result was worse.

• During pregnancy, iodine requirements are higher as there is an increased demand for thyroid hormones due to decreased levels of free thyroid hormone secondary to elevated circulating levels of thyroid binding globulin in response to increased estrogen levels.

I think it's backwards; the reader knows estrogen levels increase during pregnancy, so the sentence would be easier to get through if it started there rather than ending there. SandyGeorgia (Talk) 14:52, 23 December 2013 (UTC)

lol, I have clarified the text. Axl ¤ [Talk] 20:40, 23 December 2013 (UTC)

I knew it was a long sentence, but I wrote it when I was tired =( and wasn't sure how to rearrange it. I think the revised version is a definite improvement. Thanks Axl. I don't think we should assume all readers know estrogen levels go up during pregnancy (granted, most would and more importantly should, but I am often surprised by what readers do/do not know). TylerDurden8823 (talk) 09:07, 25 December 2013 (UTC)

Note - I hadn't noticed this page when I made some recommendations on the regular talk page. I am happy to move the advice here for completeness. JFW | T@lk 20:45, 23 December 2013 (UTC)

How about this:-

Symptoms and signs of hypothyroidism

Symptoms	Signs
Fatigue	Dry, coarse skin
Feeling cold	Cool peripheries
Poor memory and concentration	Myxedema (mucopolysaccharide deposition in the skin)
Constipation	Hair loss
Weight gain with poor appetite	Slow pulse rate
Shortness of breath	Peripheral edema
Hoarse voice	Delayed relaxation of tendon reflexes
Menorrhagia (and later oligomenorrhea)	Carpal tunnel syndrome
Paresthesia	Serous cavity effusions (pleural effusion, ascites, pericardial effusion)
Poor hearing

Axl ¤ [Talk] 01:54, 24 December 2013 (UTC)

I like it, let's make that happen in the article. Wouldn't menorrhagia be a sign though since it can be objectively measured in terms of how many days/blood lost with defined parameters for what constitutes menorrhagia? TylerDurden8823 (talk) 09:08, 25 December 2013 (UTC)

Menorrhagia is not measured objectively. It requires a statement by the patient: "I am having unusually heavy periods". Axl ¤ [Talk] 11:18, 25 December 2013 (UTC)

• From "Causes", paragraph 4: "Hypothyroidism can result from postpartum thyroiditis up to nine months after giving birth.... This condition has an incidence of about 5% in the general population." This statement could be misleading. "Incidence" refers to the number of new cases per unit population per unit time (usually per year). However postpartum disease frequencies should be described as the number of cases divided by the number of pregnancies. Incidence is not an appropriate way of describing the frequency of cases of postpartum diseases. Similarly, "the general population" is not an appropriate population group for postpartum diseases. (Does the group include men, elderly women, etc.?)

I am aware that the reference states "The incidence of PPT is 5.4% in the general population." Also, the source describes PPT occurring during one year following pregnancy, not nine months.

This source states "The prevalence varies significantly between studies from 1.1 to 21.1% [93], with estimated pooled prevalence in the general population of approximately 8%."

Another source: "The incidence of this syndrome has been estimated at anywhere from 1.9% to 21%." The population group isn't described—presumably it is self-evident.

I accept that the literature uses this terminology, but I don't think that we should be propagating their sloppy phrasing in Wikipedia. Axl ¤ [Talk] 16:10, 30 December 2013 (UTC)

Agreed, I admit I felt uncomfortable trying to force that part to work with the preexisting section on postpardium thyroiditis and had similar concerns. TylerDurden8823 (talk) 07:05, 31 December 2013 (UTC)

• The article uses a mixture of "T3" and "T₃". This should be standardized to a single style. Similarly with "T4" and "T₄". Axl ¤ [Talk] 23:11, 30 December 2013 (UTC)

I would be in favor of all of them being "T₃". TylerDurden8823 (talk) 07:05, 31 December 2013 (UTC)

• A minor point: the journal references have inconsistent formatting. Some journals are abbreviated without full stops [periods] (e.g. 3: Brown, 8: Gaitonde), some with full stops (e.g. 7: Vissenberg, 9: Persani), some in full with upper case (e.g. 5: Klubo-Gwiezdzinska, 6: van den Boogaard) and some with lower case (e.g. 15: Stagnaro-Green, 17: Pearce). Some journals have a long list of authors (e.g. 15: Stagnaro-Green, 23: Becker) while others use "et al." (e.g. 6: van den Boogaard, 7: Vissenberg). A consistent style is not required for GA status, but it is required for FA status. Axl ¤ [Talk] 12:42, 3 January 2014 (UTC)

Old list of signs and symptoms

I have moved the old list here in case anyone wants to refer to it. Axl ¤ [Talk] 10:58, 25 December 2013 (UTC)

• Appearance: thin, brittle fingernails, dry skin, weight gain (with poor appetite), puffy face, hands, feet, hair loss, thinning of the outer third of the eyebrow, enlarged tongue
• Cardiovascular: slowed heart rate, decreased blood pressure, elevated serum cholesterol, hyponatremia, pleural effusion, pericardial effusion, anemia (most commonly normocytic and normochromic) due to impaired hemoglobin synthesis (decreased erythropoietin levels), iron deficiency anemia may occur due to decreased intestinal absorption of iron; a macrocytic anemia may be caused by decreased intestinal folate absorption or Vitamin B₁₂ deficiency from pernicious anemia (sometimes seen with hypothyroidism in polyglandular autoimmune syndrome or in association with autoimmune thyroiditis)
• Constitutional: fatigue, sleepiness, cold intolerance, decreased sweating, low basal body temperature
• Endocrine: female infertility, menorrhagia, goiter, decreased libido, erectile dysfunction in men, hyperprolactinemia, galactorrhea, reactive (or post-prandial) hypoglycemia, impaired renal function with decreased glomerular filtration rate
• Gastrointestinal: constipation
• Hematological/Lymphatic: deepening of the voice due to Reinke's edema
• Neurological: depression, weakness, poor memory and concentration, hearing impairment, mood instability, irritability, slow speech and hoarse voice, loss of sense of smell, acute psychosis, (myxedema madness) (rare)
• Neuromuscular: depressed reflexes, hypotonia, paresthesias, muscle cramps, muscle weakness, joint pain, carpal tunnel syndrome, difficulty swallowing, shortness of breath with a shallow and slow respiratory pattern