Case explanation and follow up

Periorbital edema, eyebrow hair loss, voice hoarseness, dry coarse skin , bradycardia, and drowsiness are all signs of hypothyroidism.

TSH>100 supports our presumptive diagnosis.

Since there was no sign of myxedema coma (loss of consciousness, severe bradycardia, and hypothermia) there is no need for intravenous therapy.

Starting treatment with Levothyroxine seems reasonable for this patient. The usual starting dose is 1.6 microgram per kg per day, but since the patient is more than 60 years old, it is rational to start with 25-50 micrograms levothyroxine per day.

After 6 weeks, the patient came back to the clinic with complete well-being. His heart rate was 80/min and blood pressure was 130/80.
TSH 8.0
fT4 1.2