Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- non-specific symptoms
Other diagnostic factors
- lethargy
- constipation
- weight gain
- menstrual irregularity
- dry or coarse skin
- change in voice
- bradycardia
- hypertension
- delayed relaxation of tendon reflexes
- cold sensitivity
- coarse hair
- eyelid oedema
- goitre
Risk factors
- iodine deficiency
- female sex
- middle age
- family history of autoimmune thyroiditis
- autoimmune disorders
- treatment for thyroid disease
- post-partum thyroiditis
- Turner's and Down's syndromes
- type 1 diabetes
- radiotherapy to head and neck
- infiltrative disease
- iodine excess
- amiodarone use
- lithium use
Diagnostic investigations
1st investigations to order
- serum thyroid-stimulating hormone (TSH)
Investigations to consider
- free serum T4
- antithyroid peroxidase antibodies
- FBC
- fasting blood glucose
- serum cholesterol
- homocysteine
Treatment algorithm
confirmed overt primary hypothyroidism
sub-clinical hypothyroidism with TSH >10 mIU/L
Contributors
Authors
Wail Malaty, MD
Adjunct Clinical Professor
Department of Family Medicine
University of North Carolina
Chapel Hill
NC
Disclosures
WM declares that he has no competing interests.
Peer reviewers
Bernard Ewigman, MD
Professor of Medicine
Chair of Family Medicine
University of Chicago Medical Center
Chicago
IL
Disclosures
BE declares that he has no competing interests.
Salman Razvi, MD, FRCP
Consultant Endocrinologist
Queen Elizabeth Hospital
Gateshead
UK
Disclosures
SR declares that he has no competing interests.
Lakdasa Premawardhana, MBBS, FRCP, FRCPE
Consultant Physician
Caerphilly Miners' Hospital
Caerphilly
UK
Disclosures
LP declares that he has no competing interests.
Birte Nygaard, MD, PhD
Associated Professor
Consultant Endocrinologist
Herlev Hospital
University of Copenhagen
Denmark
Disclosures
BN declares that she has no competing interests.
Joaquin Lado, MD, PhD
Professor of Internal Medicine
Endocrinology Division Chief
Texas Tech University Health Sciences Center - School of Medicine
Lubbock
TX
Disclosures
JL declares that he has no competing interests.
Differentials
- Central or secondary hypothyroidism
- Depression
- Alzheimer's dementia
More DifferentialsGuidelines
- Thyroid disease: assessment and management
- Asymptomatic thyroid dysfunction (2019)
More GuidelinesPatient leaflets
Underactive thyroid
Underactive thyroid: questions to ask your doctor
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
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