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Clinical Manifestations пїЅ Extreme fatigue пїЅ Hair loss, brittle nails, dry pores and skin, and numbness and tingling of fingers пїЅ Husky voice and hoarseness пїЅ Menstrual disturbances (eg, menorrhagia or amenorrhea); loss of libido пїЅ Severe hypothyroidism: subnormal temperature and pulse rate; weight gain without corresponding improve in food intake; cachexia пїЅ Thickened pores and skin, thinning hair or alopecia; expressionless and masklike facial options пїЅ Sensation of cold in a warm environment пїЅ Subdued emotional responses as the situation progresses; dulled psychological processes and apathy пїЅ Slowed speech; enlarged tongue, hands, and ft; constipation; presumably deafness пїЅ Advanced hypothyroidism: character and cognitive modifications, pleural effusion, pericardial effusion, and respiratory muscle weakness 394 Hypothyroidism and Myxedema пїЅ Hypothermia: irregular sensitivity to sedatives, opiates, and anesthetic agents (these drugs are given with extreme warning) пїЅ Severe hypothyroidism: elevated serum cholesterol degree, atherosclerosis, coronary artery illness, and poor left ventricular function пїЅ Myxedema coma (rare) Gerontologic Considerations the higher prevalence of hypothyroidism within the aged population could also be associated to alterations in immune operate with age. 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