Case history
Case history
A 45-year-old white woman presents with symptoms of fatigue, depression, and mild weight gain. Physical exam demonstrates a heart rate of 58 beats per minute, coarse dry skin, and bilateral eyelid edema. 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 asymptomatic patients with only mildly elevated thyroid-stimulating hormone and a normal serum free T4, the diagnosis is subclinical hypothyroidism.[3]
Rarely, older patients with overwhelming infections or who are oversedated can present with a severe form of hypothyroidism, myxedema coma.[4] Most patients have a reduced level of consciousness, hypothermia, and often have heart and respiratory failure.
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