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 Blood TSH concentration

 If the TSH concentration is high, the test should be repeated and T4 should be quantified

 The measurement of thyroid peroxidase antibodies can be useful for confirming the diagnosis of primary autoimmune hypothyroidism

 In the presence of additional clinical findings such as an irregular thyroid gland when palpated, ultrasonography is indicated (Figure 5.2.4)Table 5.2.2 Clinical manifestations of hypothyroidism.CategorySymptomsSignsGeneralFatigue Weight gain Intolerance to cold DrowsinessHypothermia Increased body mass index Reduced metabolic activity MyxoedemaCardiovascularShortness of breath Fatigue with exerciseHypertension Bradycardia Ischaemic heart disease Pleural effusionHaematologicalProne to bleedingAnaemia Von Willebrand diseaseMusculoskeletalJoint pain MyalgiaIncreased creatine phosphokinase levelsGastrointestinalIntake problems ConstipationOesophageal motility disorderSkin and hairDry skin Hair lossFine hair Thickened skin Loss of eyebrow tailSensorineuralHusky voice Dysgeusia Vision loss Hearing lossNeuropathy Cochlear dysfunctionEndocrinologicalInfertility Menstrual disorders GalactorrhoeaGoitre Blood sugar dysregulation Increase in prolactinPsychologicalMemory loss Depression DementiaCognitive impairment

Figure 5.2.4 Grey‐scale ultrasound and colour Doppler sonogram showing multiple micronodules in diffuse Hashimoto thyroiditis (right thyroid lobe).