Clinical features

An insidious onset with vague, non-specific and diverse features is characteristic. Diagnosis is often made incidentally. Mild cases may be completely asymptomatic.

General:

• fatigue, weight gain, and cold intolerance; less commonly, goitre and hyperlipidaemia

Dermatological:

• dry, scaly, cold and thickened skin; malar flush imposed against a generally pale complexion; alopecia with coarse and brittle hair; occasionally, vitiligo

Neuromuscular:

• hoarse voice; aches and pains in the muscles and joints; syndromes such as carpal tunnel and cerebellar ataxia; deafness; depression or more bizarre psychiatric features - myxoedema madness; delayed ankle jerk reflex

Haematologic:

• anaemia - usually normocytic, normochromic; but may be microcytic and hypochromic due to blood loss from menorrhagia; or macrocytic due to vitamin B12 deficiency associated with pernicious anaemia

Cardiovascular:

• bradycardia, angina, cardiac failure, pericardial and pleural effusions

Gastrointestinal:

• constipation, ileus, ascites

Reproductive:

• impotence, menorrhagia, galactorrhoea, hyperprolactinaemia

Developmental:

• growth and mental retardation; delayed puberty