Clinical manifestations of hypothyroidism
- Martin I Surks, MD
Martin I Surks, MD
- Professor of Medicine and Pathology
- Albert Einstein College of Medicine
Whether hypothyroidism results from hypothalamic-pituitary disease or primary thyroid disease, symptoms and signs of the disease vary in relation to the magnitude of the thyroid hormone deficiency and the acuteness with which the deficiency develops. Hypothyroidism is less prominent clinically and better tolerated when there is a gradual loss of thyroid function (as in most cases of primary hypothyroidism) than when it develops acutely after thyroidectomy or abrupt withdrawal of exogenous thyroid hormone.
The typical clinical manifestations of hypothyroidism may be modified by factors such as coexisting nonthyroidal illness. Furthermore, when hypothyroidism is caused by hypothalamic-pituitary disease, the manifestations of associated endocrine deficiencies such as hypogonadism and adrenal insufficiency may mask the manifestations of hypothyroidism. Finally, when hypothyroidism follows treatment of Graves' hyperthyroidism, some manifestations of Graves' disease, such as ophthalmopathy and vitiligo, may persist throughout the patient's life.
This topic will review the major clinical manifestations of hypothyroidism. The diagnosis and treatment of hypothyroidism, subclinical hypothyroidism, and goiter are discussed separately. (See "Diagnosis of and screening for hypothyroidism in nonpregnant adults" and "Treatment of primary hypothyroidism in adults" and "Subclinical hypothyroidism in nonpregnant adults" and "Clinical presentation and evaluation of goiter in adults".)
Many of the manifestations of hypothyroidism reflect one of two changes induced by lack of thyroid hormone (table 1):
●A generalized slowing of metabolic processes. This can lead to abnormalities such as fatigue, slow movement and slow speech, cold intolerance, constipation, weight gain (but not morbid obesity), delayed relaxation of deep tendon reflexes, and bradycardia.
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- CLINICAL MANIFESTATIONS
- - Anemia
- Cardiovascular system
- Respiratory system
- Gastrointestinal disorders
- Reproductive abnormalities
- Neurologic dysfunction
- - Hashimoto encephalopathy
- - Myxedema coma
- - Carpal tunnel
- Musculoskeletal symptoms
- Metabolic abnormalities
- Drug clearance
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