Treatment is with T 4 at a maintenance dose of 75–200&g/day. Response is measured clin-
ically and biochemically by the return of TSH to the normal range. Elderly patients or
those with coronary heart disease should be started cautiously on T 4 because of the risk of
precipitating myocardial ischaemia.
- Hypothyroidism should be considered in the differential diagnosis of any patient pre-
senting with fatigue. - A neurological examination should be part of the routine assessment of such patients.
- Clinical symptoms of hypothyroidism are usually non-specific.
- Hypothyroidism may present in unusual ways such as psychoses or decreased conscious
level. - Autoimmune thyroiditis is the commonest cause of hypothyroidism.