Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences

Alen Omanovic; Nejra Mlaco-vrazalic; Akif Mlaco

doi:10.46310/tjim.1784722

Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences

Abstract

Objective: To describe patient-reported symptoms of hypothyroidism in a primary care cohort and perform an exploratory assessment of potential gender differences. Methods: This retrospective observational study included 1000 patients with confirmed hypothyroidism treated at the Public Institution Health Care Centre Visoko between January and October 2024. Data were extracted from electronic medical records. Collected variables included age, gender, comorbidities, family history, pregnancy status, and reported symptoms. Descriptive statistics were performed for the entire cohort. Exploratory logistic regression analyses were used to assess potential gender differences in reported symptoms. Results: The cohort comprised 921 (92.1%) female and 79 (7.9%) male patients, with a mean age of 57±14.6 years. The most commonly reported symptoms were hyperhidrosis (97%), fatigue (96.6%), and heart palpitations (83.5%). Male patients showed a higher likelihood of reporting heart palpitations (OR 2.42, p=0.03) and bowel problems (OR 2.03, p=0.01), and a lower likelihood of reporting neck tightness (OR 0.26, p<0.001) and tearfulness (OR 0.045, p<0.001). Conclusion: In this primary care cohort, the reported symptom burden was largely nonspecific and reflects real-world patient-reported complaints rather than classical manifestations of overt hypothyroidism. Exploratory analyses suggested potential gender-related differences; however, the low number of male patients limits firm conclusions. Larger prospective studies are needed to confirm these observations.

Keywords

References

1. Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J, eds. Harrison’s Principles of Internal Medicine. 21st ed. New York, NY: McGraw-Hill Education; 2022.
2. Gottwald-Hostalek U, Schulte B. Low awareness and under-diagnosis of hypothyroidism. Curr Med Res Opin. 2022;38(1):59-64. doi:10.1080/03007995.2021.1997258.
3. Diab N, Daya NR, Juraschek SP, Martin SS, McEvoy JW, Schultheiß UT, et al. Prevalence and risk factors of thyroid dysfunction in older adults in the community. Sci Rep. 2019;9:13156. doi:10.1038/s41598-019-49540-z.
4. Chiovato L, Magri F, Carlé A. Hypothyroidism in context: where we’ve been and where we’re going. Adv Ther. 2019;36(1):47-58. doi:10.1007/s12325-019-01080-8.
5. Lillevang-Johansen M, Abrahamsen B, Jørgensen HL, Brix TH, Hegedüs L. Duration of over- and undertreatment of hypothyroidism is associated with increased cardiovascular risk. Eur J Endocrinol. 2019;180(4):407-16. doi:10.1530/EJE-19-0006.
6. Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet. 2020;396(10250):565-82. doi:10.1016/S0140-6736(20)31561-0.
7. Castello R, Caputo M. Thyroid diseases and gender. Ital J Gender-Specific Med. 2019;5(4):136-41. doi:10.1723/3245.32148.
8. Himabindu HP, Swathi G, Padmavathi K, Sumangali P, Ramesh K. Hypothyroidism and its impact on menstrual irregularities in reproductive-age women: a comprehensive analysis at a tertiary care center. Cureus. 2024;16(8):e63158. doi:10.7759/cureus.63158.

9. Shen M, Li X, Wu W, Dou R, Mei X, Xu W, et al. Is there an association between hypothyroidism and sexual dysfunction: a systematic review and cumulative analysis. Sex Med. 2021;9(3):100345. doi:10.1016/j. esxm.2021.100345.
10. Garrow A, Weinhouse GL. Overview of the clinical manifestations of hyperthyroidism in adults. In: UpToDate [Internet]. Waltham (MA): UpToDate Inc. Available from: https://www.uptodate.com. Accessed 2025 Jan 4.
11. Garrow A, Weinhouse GL. Clinical manifestations of hypothyroidism. In: UpToDate [Internet]. Waltham (MA): UpToDate Inc. Available from: https://www.uptodate.com. Accessed 2025 Jan 4.
12. Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P. Gender differences in symptoms of hypothyroidism: a population-based DanThyr study. Clin Endocrinol (Oxf ). 2015;83(5):717-25. doi:10.1111/ cen.12787.
13. Olmos RD, Figueiredo RC, Aquino EM, Lotufo PA, Bensenor IM. Gender, race and socioeconomic influence on diagnosis and treatment of thyroid disorders in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Braz J Med Biol Res. 2015;48(8):751-8. doi:10.1590/1414-431X20154445.
14. Haum M, Kellnar A, Thienel M, Lackermair K. Review: sex-related differences in the treatment of cardiac arrhythmia. Pharmacol Ther. 2023;244:108388. doi:10.1016/j.pharmthera.2023.108388.
15. Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the heart. Methodist Debakey Cardiovasc J. 2017;13(2):55-9. doi:10.14797/mdcj-13-2-55.
16. Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-35. doi:10.1161/ CIRCULATIONAHA.106.678326.
17. Osman F, Franklyn JA, Holder RL, Sheppard MC, Gammage MD. Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: A matched case-control study. J Am Coll Cardiol. 2007;49(1):71-81. doi:10.1016/j.jacc.2006.08.042.
18. McCrea GL, Miaskowski C, Stotts NA, Macera L, Paul SM, Varma MG. Gender differences in self-reported constipation characteristics, symptoms, and bowel and dietary habits among patients attending a specialty clinic for constipation. Gend Med. 2009;6(1):259-71. doi:10.1016/j.genm.2009.04.007.
19. McCrea GL, Miaskowski C, Stotts NA, Macera L, Varma MG. A review of the literature on gender and age differences in the prevalence and characteristics of constipation in North America. J Pain Symptom Manage. 2009;37(5):737-45. doi:10.1016/j.jpainsymman.2008.04.016.
20. Malboosbaf R, Hosseinpanah F, Mojarrad M, Jambarsang S, Azizi F. Relationship between goiter and gender: a systematic review and meta-analysis. Endocrine. 2013;43(3):539-47. doi:10.1007/s12020-012-9831-8.
21. Sharman LS, Dingle GA, Baker M, Fischer A, Gračanin A, Kardum I, et al. The relationship of gender roles and beliefs to crying in an international sample. Front Psychol. 2019;10:2288. doi:10.3389/fpsyg.2019.02288.

Details

Primary Language

English

Subjects

Endocrinology , Internal Diseases

Journal Section

Research Article

Authors

Alen Omanovic
0000-0001-7755-7796
Bosnia and Herzegovina

Nejra Mlaco-vrazalic ^*
0000-0002-3299-6899
Bosnia and Herzegovina

Akif Mlaco
0000-0002-1907-9017
Bosnia and Herzegovina

Publication Date

February 26, 2026

Submission Date

September 15, 2025

Acceptance Date

February 20, 2026

Published in Issue

Year 2026 Volume: 8

DOI

https://doi.org/10.46310/tjim.1784722

IZ

https://izlik.org/JA98BU72CJ

Cite

RIS / Bibtex

APA

Omanovic, A., Mlaco-vrazalic, N., & Mlaco, A. (2026). Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences. Turkish Journal of Internal Medicine, 8, 4-11. https://doi.org/10.46310/tjim.1784722

AMA

1.Omanovic A, Mlaco-vrazalic N, Mlaco A. Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences. Turk J Int Med. 2026;8:4-11. doi:10.46310/tjim.1784722

Chicago

Omanovic, Alen, Nejra Mlaco-vrazalic, and Akif Mlaco. 2026. “Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences”. Turkish Journal of Internal Medicine 8 (February): 4-11. https://doi.org/10.46310/tjim.1784722.

EndNote

Omanovic A, Mlaco-vrazalic N, Mlaco A (February 1, 2026) Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences. Turkish Journal of Internal Medicine 8 4–11.

IEEE

[1]A. Omanovic, N. Mlaco-vrazalic, and A. Mlaco, “Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences”, Turk J Int Med, vol. 8, pp. 4–11, Feb. 2026, doi: 10.46310/tjim.1784722.

ISNAD

Omanovic, Alen - Mlaco-vrazalic, Nejra - Mlaco, Akif. “Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences”. Turkish Journal of Internal Medicine 8 (February 1, 2026): 4-11. https://doi.org/10.46310/tjim.1784722.

JAMA

1.Omanovic A, Mlaco-vrazalic N, Mlaco A. Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences. Turk J Int Med. 2026;8:4–11.

MLA

Omanovic, Alen, et al. “Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences”. Turkish Journal of Internal Medicine, vol. 8, Feb. 2026, pp. 4-11, doi:10.46310/tjim.1784722.

Vancouver

1.Alen Omanovic, Nejra Mlaco-vrazalic, Akif Mlaco. Clinical Presentation of Hypothyroidism in a Primary Care Cohort: An Exploratory Analysis of Gender Differences. Turk J Int Med. 2026 Feb. 1;8:4-11. doi:10.46310/tjim.1784722