Adult hypothyroidism. 1. Manifestations and clinical presentation.

Hypothyroidism ranges in severity from subtle alterations of thyroid function to myxedema coma. Its manifestations in other organ systems or as behavioral changes effectively draw attention away from the thyroid. Normal findings on physical examination and an elevated serum thyroid-stimulating hormone (TSH) level are characteristic of mild hypothyroidism. Therapy with thyroid hormone may be indicated. Myxedema coma is an endocrine emergency, usually precipitated by some stressful event, eg, infection, medication, exposure to cold, severe hemorrhage. Because time is usually insufficient for full-scale endocrine evaluation, diagnosis must be based on history, physical examination, and exclusion of other causes of coma.