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secretion of thyroid hormones by the thyroid gland. There are several distinct causes for chronic hypothyroidism, most common being Hashimoto's thyroiditis and iatrogenic (or postoperative) hypothyroidism following radioiodine therapy for hyperthyroidism.

The severity of hypothyroidism varies widely. Some patients are classified as subclinical hypothyroid when only diagnostic findings show thyroid

for other diseases and states. Advanced hypothyroidism is easily recognized even for non-specialist.

1 Signs and symptoms

• Slowed speech and impaired memory
• Cold intolerance
• A slow heart rate and sluggish reflexes
• Dry puffy skin and hair loss
• Can contribute to depression
• May lead to weight gain

In the elderly, hypothyroidism is relatively common and can be easily missed. It is an important but treatable cause of depression in this age group.

2 Neonatal period

Thyroid hormone is very important to neural development in the neonatal period. A deficiency of thyroid hormones can lead to cretinism. For this reason it is important to detect and treat thyroid deficiency early. In Australia and many other countries this is done by testing for TSH on the routine neonatal heel pricks performed by law on all new born babies.

3 Hashimoto's thyroiditis

Sometimes called Hashimoto's Disease, this is part of the spectrum of auto-immune diseases and is related to Graves' disease, lymphocyticA lymphocyte is a type of white blood cell involved in the human body's immune system. There are two broad categories of lymphocytes, namely T cells and B cells. Lymphocytes play an important and integral part of the body's defenses. T-cells are responsib thyroiditis as well as other organ related auto-immune conditions such as Addison's diseaseAddison's disease (also known as chronic adrenal insufficiency or hypocortisolism is a rare endocrine disorder. It is estimated that it affects about 1 to 5 in 100,000 people. It occurs when the adrenal glands, seated above the kidneys, fail to produce en, diabetes, premature menopause and vitiligoVitiligo (or leukoderma is the patchy loss of skin pigmentation due to an auto-immune attack by the body's own immune system on skin melanocytes. It frequently begins in late adulthood, with patches of unpigmented skin appearing on extremities. The patche. Hashimoto's is a lymphocytic and plasmacytic thyroid inflammationInflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. Inflammation is characterized by the following quintet: redness rubor , heat calor , swelling tumor , pain dolor and dysfuncti that eventually destroys the thyroid. Patients require permanent thyroid replacement.

4 Pituitary failure

Reduction or loss of TSH secretion by the pituitary is a very rare cause of hypothyroidism.