The symptoms of hypothyroidism (Fig. 15.28) are non-specific and may be attributed by both patient and doctor to ageing, the onset usually being insidious. The diagnosis of hypothyroidism should be considered in the absence of other obvious explanations, particularly in older women with any of the above symptoms. These symptoms may be even less apparent in secondary hypothyroidism, depending upon the degree of failure of other pituitary hormones. Overt hypothyroidism with thickened, dry, cool skin, which led to the term myxoedema (see Severe Hypothyroidism), is often well advanced before it is recognised clinically.
