Case history
Case history
A 45-year-old white woman presents with symptoms of fatigue, depression, and mild weight gain. Physical examination demonstrates heart rate of 58 beats per minute, coarse dry skin, and bi-lateral eyelid oedema. Serum thyroid-stimulating hormone (TSH) is elevated and free thyroxine (T4) levels are low. Therapy is begun with levothyroxine and the patient's symptoms improve. Repeat testing 6 weeks later reveals a normal TSH.
Other presentations
Many patients have no symptoms or vague symptoms (e.g., feeling slow) that are not specific to hypothyroidism. In cases where the TSH is only mildly elevated, the patient is not symptomatic, and the serum free T4 is normal, the diagnosis is sub-clinical hypothyroidism.[2]
Rarely, older patients with overwhelming infections or who are over-sedated can present with a severe form of hypothyroidism, myxoedema coma.[3] Most patients have a reduced level of consciousness, hypothermia, and often have heart and respiratory failure.
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