Summary
Definition
History and exam
Key diagnostic factors
- nonspecific symptoms
Other diagnostic factors
- lethargy
- constipation
- weight gain
- depression
- menstrual irregularity
- dry or coarse skin
- change in voice
- bradycardia
- hypertension
- delayed relaxation of tendon reflexes
- cold sensitivity
- coarse hair
- eyelid edema
- goiter
Risk factors
- iodine deficiency
- female sex
- middle age
- family history of autoimmune thyroiditis
- autoimmune disorders
- treatment for thyroid disease
- postpartum thyroiditis
- Turner and Down syndromes
- type 1 diabetes
- radiation therapy to head and neck
- infiltrative disease
- iodine excess
- exposure to pesticides
- amiodarone use
- lithium use
- laryngectomy
- treatment for multidrug-resistant tuberculosis (TB)
Diagnostic tests
1st tests to order
- serum thyroid-stimulating hormone (TSH)
Tests to avoid
- thyroid ultrasound
Tests to consider
- free serum thyroxine (T4)
- antithyroid peroxidase antibodies (anti-TPOAbs)
- CBC
- fasting blood glucose
- serum cholesterol
Treatment algorithm
confirmed overt primary hypothyroidism
subclinical hypothyroidism
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
Sun Y. Lee, MD, MSc
Assistant Professor of Medicine
Boston University School of Medicine
Boston
MA
Disclosures
SYL declares that she 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Taylor PN, Medici MM, Hubalewska-Dydejczyk A, et al. Hypothyroidism. Lancet. 2024 Oct 5;404(10460):1347-64. Abstract
Alexander EK, Pearce EN, Brent GA, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017 Mar;27(3):315-89.Full text Abstract
American Association of Clinical Endocrinologists; American Thyroid Association. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028.Full text Abstract
Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014 Dec;24(12):1670-751.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Central or secondary hypothyroidism
- Depression
- Alzheimer dementia
More DifferentialsGuidelines
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- Thyroid disease in pregnancy
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Underactive thyroid
Underactive thyroid: questions to ask your doctor
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