• Sleepiness

• Mental impairment

• Depression

• Cold intolerance

• Hoarseness

• Decreased perspiration

• Decreased appetite

• Constipation

• Menstrual disturbances

• Arthralgia

• Paresthesia Signs

• Slow movements

• Hoarseness

• Bradycardia

• Nonpitting edema (myxedema)

• Hyporeflexia

• Delayed relaxation of reflexes Screening/Diagnosis

A TSH level of 4.5 to 10 milliunits/L constitutes mild or subclinical hypothyroidism, and some patients with a TSH level of 2.5 to 4.5 milliunits/L also may be mildly hypothyroid. A TSH level greater than 10 milliunits/L signifies overt hypothyroidism.0 The free T4 level will be normal (0.7-1.9 ng/dL or 9.0-24.5 pmol/L) in mild or subclinical hypothyroidism and low (less than 0.7 ng/dL or 9.0 pmol/L) in patients with obvious signs and/or symptoms.

a Milliunits/L (mU/L) = microunits/mL (p,U/mL); clinical laboratories use either unit of measurement. From Refs. 11, 12.

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