Zulewski Clinical Score (Hypothyroidism)
The Zulewski clinical score (Zulewski and colleagues 1997) rates clinical suspicion of hypothyroidism from 7 symptoms…
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Age in years
- 40 years
- SYMPTOM: Diminished sweating
- Yes
- SYMPTOM: Hoarseness of the voice
- Yes
- SYMPTOM: Paresthesia
- No
- SYMPTOM: Dry skin
- No
- SYMPTOM: Constipation
- No
- SYMPTOM: Impairment of hearing
- No
- SYMPTOM: Weight increase
- No
- SIGN: Slow movements
- No
- SIGN: Delayed ankle reflex
- No
The other 3 values
- SIGN: Coarse skin - roughness and thickening felt on the hands
- Yes
- SIGN: Periorbital puffiness - enough to obscure the curve of the malar bone
- No
- SIGN: Cold skin - the patient's hands compared with the examiner's own
- No
Result: 4
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Symptoms
- 7 items, 1 point each: diminished sweating, hoarseness, paresthesia, dry skin, constipation, hearing impairment, weight increase.
- Signs
- 5 items, 1 point each: slow movements, delayed ankle reflex, coarse skin, periorbital puffiness, cold skin.
- Age
- ADD 1 POINT WHEN THE PATIENT IS UNDER 55. Most reproductions drop this. A patient under 55 with no findings scores 1, not 0.
- Maximum
- With the correction the true maximum is 13, not the 12 that item tables print.
- Split
- Sources that print the item table omit the correction; sources that state the correction omit the table.
- 0 to 2
- Euthyroid - no or low suspicion.
- 3 to 5
- Intermediate suspicion.
- Above 5
- The overt hypothyroid range - high suspicion.
- Bands
- Set on the CORRECTED score. The age point ALONE moves the band at both boundaries, 2 to 3 and 5 to 6.
- Skin
- THREE separate items, a quarter of the score: dry skin is a symptom, coarse skin is felt on hands and forearms, cold skin against the examiner hands.
- TSH
- IT DOES NOT CORRELATE WITH TSH. It tracks free T4 and free T3 only. A high score is a reason to MEASURE TSH, never a substitute.
- Lineage
- The items were originally chosen by Billewicz, so this is that older index re-derived, not an independent instrument.
- Scope
- Rates clinical suspicion. Does not diagnose or grade hypothyroidism and does not start, stop or dose levothyroxine.
What you enter
- Age in years.
- SYMPTOM: Diminished sweating.
- SYMPTOM: Hoarseness of the voice.
- SYMPTOM: Paresthesia.
- SYMPTOM: Dry skin (patient-reported).
- SYMPTOM: Constipation.
- SYMPTOM: Impairment of hearing.
- SYMPTOM: Weight increase.
- SIGN: Slow movements.
- SIGN: Delayed ankle reflex.
The other 3 fields
- Age in years. Under 55 ADDS 1 point - the correction most reproductions drop.
- SYMPTOM: Diminished sweating. 1 point if present.
- SYMPTOM: Hoarseness of the voice. 1 point if present.
- SYMPTOM: Paresthesia. 1 point if present.
- SYMPTOM: Dry skin (patient-reported). 1 point if present.
- SYMPTOM: Constipation. 1 point if present.
- SYMPTOM: Impairment of hearing. 1 point if present.
- SYMPTOM: Weight increase. 1 point if present.
- SIGN: Slow movements. 1 point if present.
- SIGN: Delayed ankle reflex. 1 point if present.
- SIGN: Coarse skin - roughness and thickening felt on the hands, forearms and elbows. 1 point if present.
- SIGN: Periorbital puffiness - enough to obscure the curve of the malar bone. 1 point if present.
- SIGN: Cold skin - the patient's hands compared with the examiner's own. 1 point if present.
How this is calculated
Zulewski H, Muller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab. 1997;82(3):771-776. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.