The diagnosis of an underactive thyroid gland is confirmed with below normal serum thyroxine levels. Also known as myxoedema.
Many patients with hypothyroidism will gain weight.
Constipation frequently occurs in hypothyroidism.
However, coeliac disease may also be associated with auto-immune thyroid disease which may present with a change in bowel habit and weight loss.
Low mood may be associated with a hypothyroidism diagnosis.
Many patients with hypothyroidism have a profound lack of energy and complain of feeling tired all the time.
Many patients with hypothyroidism will complain of feeling tired, despite sleeping well.
Cold intolerance is typical with hypothyroidism.
Premature ovarian failure may also be associated with auto-immune thyroid disease and may present with oligomenorrhoea and hot flushes.
Dry, doughy and rough skin often occur in hypothyroidism.
Increased pigmentation may indicate associated Addison’s disease.
Classic changes are of losing the outer third of the eyebrows in hypothyroidism, though diffuse hair loss may also be seen.
Postural hypotension may occur with bradycardia and with Addison's disease.
Menorrhagia and polymenorrhoea may occur with hypothyroidism.
Pregnancy is more likely to be achieved with a normal TSH.
There is some evidence of developmental problems in offspring of mothers with unrecognised hypothyroidism.
Bradycardia is usually asymptomatic, but the patient may complain of 'palpitations'.
Breathlessness on exertion, or swollen ankles might indicate congestive cardiac failure.
Severe but transient painful neck swelling is suggestive of thyroiditis.
Discomfort from a diffusely enlarged firm gland may occur with Hashimoto’s thyroiditis which may mimic a discrete nodule.
The development of a new swelling within a firm gland raises the possibility of lymphoma or other malignancy.
A short history of thyroid swelling should always alert to the possibility of thyroid cancer and demands ultrasound guided fine needle aspiration assessment.
Ask specifically whether their eyes have been feeling gritty or dry, as though there is something stuck in them. Have their eyes looked red or puffy at times? Has their appearance or vision has changed?
These symptoms indicate Graves' disease which can occasionally present with hypothyroidism, though usually causes thyrotoxicosis.
Long standing hoarseness may occur with hypothyroidism.
However, changes should always alert to the possibility of thyroid cancer particularly anaplastic thyroid cancer and requires urgent assessment.
Thyroid cancer, multinodular goitres and auto-immune thyroid disease may all occur more frequently within family members.
Any of these may be associated with auto-immune thyroid dysfunction.
Thyroiditis typically follows a viral illness, though this is frequently unrecognised.
Exposure to radiation increases the risk of hypothyroidism and thyroid cancer.
Smoking increases the risk and severity of ophthalmopathy in auto-immune thyroid disease.