A publication of the American Thyroid Association

Summaries for Patients from Clinical Thyroidology by Ernest Mazzaferri, MD MACP
Table of Contents| PDF File for Saving and Printing


Abbreviations & Definitions

ED is erectile dysfunction

SHIM Sexual Health Inventory for Males is a validated and widely used five-item questionnaire concerning a man’s ability to attain and maintain an erection.

SHIM Score Mild ED 17 to 21, Moderate ED, 1–16, Severe ED ≤10

The following web link has a summary of the test questions

What is the study about? Men with hyperthyroidism or hypothyroidism commonly have erectile dysfunction .

The full article title: “Erectile dysfunction in patients with hyperand hypothyroidism: how common and should we treat? ” It is in the May 2008 Issue of the Journal of Clinical Endocrinology and Metabolism (Volume 93 Issue 5, pages 1815-1819). The authors are GE Krassas, K Tziomalos, F Papadopoulou, N Pontikides, and P Perros. The abstract can be obtained from:

What is known about the problem being studied? Erectile dysfunction (ED) is a common disability associated with aging and numerous diseases. Symptoms of ED for 3 months are usually required to establish the diagnosis.

What was the aim of the study? The aim was to investigate the impact of hyperthyroidism and hypothyroidism on the health of male sexual function and dysfunction.

Who was studied? The study included 71 subjects, 27 with hyperthyroidism and 44 with hypothyroidism, and 71 euthyroid controls. The mean age was 52.6 years for the hyperthyroid group, 55.9 for the hypothyroid group, and 54 for the control group.

How was the study done? The study was done with the Sexual Health Inventory for Males (SHIM) instrument, which is a validated and widely used five-item questionnaire concerning a man’s ability to attain and maintain an erection.

What were the results of the study? In all, 79% of men with thyroid dysfunction had a SHIM score ≤21, indicating some degree of ED, 52% with hypothyroidism and 27%) with hyperthyroidism, compared with 24 controls (34%) with a similar ED score. Severe ED (SHIM ≤10) was found in almost 38.%, (295%) with hypothyroidism and 29.6% with hyperthyroidism, as compared with 25 % in 6 controls. ED was found in a significantly larger number of patients with hyperthyroidism (71%) and hypothyroidism (85%) as compared with controls (25%).

As assessed by the international SHIM instrument, approximately 80% of the patients in this study had ED, as compared with 37.5% of the Back to Table of Contentscontrols. After euthyroidism was restored, 30% of the patients had ED, a rate similar to that in controls.

How does this compare with other studies? and similar tests have been widely used since medications to treat ED became available. A 2008 review by Derogatis points out that the recent recognition of the high prevalence of sexual dysfunctions and disorders in our society, along with the development of drugs to treat ED, has resulted in a significant expansion in the development of valid and reliable measures of sexual function/dysfunction. He explains that the instruments generally are brief self-report inventories, typically requiring 10 to 20 minutes of patient time for completion. All of these instruments, which must adhere to recently prescribed rigorous guidelines set forth by the Food and Drug Administration, have been demonstrated to be valid and reliable indicators of the status and quality of sexual functioning in both men and women. The review by DeRogais is available at

What are the Limitations of this study? The mechanism by which thyroid dysfunction can cause ED has not been investigated.

What are the implications of this study? Men with thyroid dysfunction commonly have ED that is reversible with restoration of the euthyroid state. Although screening for ED is recommended for these men, specific treatment should be postponed for at least 6 months after restoring euthyroidism because it may take this long for ED to spontaneously resolve

Table of Contents