Last reviewed: September 2018
Last updated: June  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
Full details

Other diagnostic factors

  • weakness
  • lethargy
  • cold sensitivity
  • constipation
  • weight gain
  • depression
  • menstrual irregularity
  • myalgia
  • dry or coarse skin
  • eyelid oedema
  • thick tongue
  • facial oedema
  • coarse hair
  • bradycardia
  • deep voice
  • diastolic hypertension with or without narrow pulse pressure
  • delayed relaxation of tendon reflexes
  • goitre
Full details

Risk factors

  • iodine deficiency
  • female sex
  • middle age
  • FHx of autoimmune thyroiditis
  • autoimmune disorders
  • Graves' disease
  • post-partum thyroiditis
  • Turner's and Down's syndromes
  • type 1 diabetes
  • primary pulmonary hypertension
  • multiple sclerosis
  • radiotherapy
  • infiltrative disease
  • iodine excess
  • amiodarone use
  • lithium use
  • textile workers
Full details

Diagnostic investigations

1st investigations to order

  • serum TSH
Full details

Investigations to consider

  • free serum T4
  • serum cholesterol
  • FBC
  • fasting blood glucose
  • serum CK
  • serum sodium
  • antithyroid peroxidase antibodies
Full details

Treatment algorithm

ONGOING

confirmed overt primary hypothyroidism

sub-clinical hypothyroidism with TSH over 10 milli-international units/L

Contributors

Authors VIEW ALL

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 VIEW ALL

Professor of Medicine

Chair of Family Medicine

University of Chicago Medical Center

Chicago

IL

Disclosures

BE declares that he has no competing interests.

Consultant Endocrinologist

Queen Elizabeth Hospital

Gateshead

UK

Disclosures

SR declares that he has no competing interests.

Consultant Physician

Caerphilly Miners' Hospital

Caerphilly

UK

Disclosures

LP declares that he has no competing interests.

Associated Professor

Consultant Endocrinologist

Herlev Hospital

University of Copenhagen

Denmark

Disclosures

BN declares that she has no competing interests.

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.

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