Wayne’s index

by Shimin Chen, year 3, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia

2 May 2016

In the 1950s, T3 and T4 testing was still to come. The only available test was protein-bound iodine (PBI), which was fairly unreliable.

In 1960, Sir Edward Wayne described a scale named Wayne’s index to improve the accuracy of diagnosis of hyperthyroidism and also to limit the need for other diagnostic tests [Imam and Ahmad, 2016].

This index of signs and symptoms is a clinical scoring tool to evaluate the presence and degree of hyperthyroidism [M. Galia et al., 2010]. It is also useful in resource challenged regions or when thyroid function tests results are at variance with clinical suspicion. With a score ranging from +45 to -25, a score less than 11 defines “euthyroidism” while scoring above 19 suggests “toxic hyperthyroidism”.

Although this system of scoring has very little relevance today, it is a useful guide to the relative importance of clinical features in the diagnosis of hyperthyroidism.

Symptoms, in order of importance Points if present Points if absent
Heat intolerance (cold preference) 5
Heat preference -5
Appetite – increased 3
Weight – decreased -3
Excessive sweating 3
Palpitations 2
Fatigue 2
Nervousness (anxiety) 2
Dyspnoea 1
Signs, in order of importance
Hyperkinetic movements 4
Atrial fibrillation 4
Thyromegaly 3 -3
Tachycardia 3
Bruit 2 -2
Exophthalmos 2
Hot hands 2
Lid retraction 2
Lid lag 1
Wet/ moist hands 1
Tremors 1

 

  • Total score (Kendall-Taylor, 1972): > 19 = toxic
  • 11-19 = equivocal
  • < 11 = euthyroid

References

  • Galia, A., Aimee A. Andag-Silva, A., Sjoberg A. Kho, S., OL San Luis, Jr, T. and Magboo-Gaviola, M. (2010). Validation of the UST Thyroid Scoring Index Against Ultrasensitive Assays for Thyroid-Stimulating Hormone and Free Thyroxine. Phil. Journal of Internal Medicine, 48(1), p.15.
  • Imam SK, Ahmad SI (2016). Thyroid disorders: basic science and clinical practice, Springer International Publishing, Switzerland, 2016, pp.76-77.
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