Hypothyroidism - primary

Early symptoms:

• Weakness
• Fatigue
• Cold intolerance
• Constipation
• Weight gain  
• Depression
• Muscle or joint pain
• Thin, brittle fingernails
• Thin, brittle hair
• Paleness

Late symptoms:

• Slow speech
• Dry flaky skin
• Thickening of the skin
• Puffy face , hands, and feet
• Decreased sense of taste and smell
• Thinning of eyebrows
• Hoarseness
• Menstrual disorders

Physical examination may reveal a smaller than normal gland, though sometimes the gland is normal in size or even enlarged (goiter). Other physical findings include pale, yellow, and dry skin; thin, brittle hair; loss of the edges of the eyebrows; coarse facial features; firm swelling of the arms and legs; and slow muscle relaxation when reflexes are tested. Vital signs may reveal a slow heart rate, low blood pressure, and low temperature.

A chest x-ray sometimes reveals an enlarged heart.

Laboratory tests to determine thyroid function include:

• Free T4 test (low)
• Total T3 or free T3 (low)
• Serum TSH (high)

Additional laboratory abnormalities may include:

• Increased cholesterol levels
• Increased liver enzymes
• Increased serum prolactin
• Low serum sodium
• A complete blood count (CBC) shows anemia