Summary
Definition
History and exam
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 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 and Down syndromes
- type 1 diabetes
- radiotherapy to head and neck
- infiltrative disease
- iodine excess
- exposure to pesticides
- amiodarone use
- lithium use
- laryngectomy
- treatment for multidrug-resistant tuberculosis (TB)
Diagnostic investigations
Investigations to consider
- free serum thyroxine (T4)
- antithyroid peroxidase antibodies (anti-TPOAbs)
- FBC
- fasting blood glucose
- serum cholesterol
Treatment algorithm
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.
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 here.
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