[Unusual presenting symptoms of hypothyroidism]

The assumption that hypothyroidism has a typical presentation can lead to error. Although a common disease in adults and easily treated, the diagnosis can be missed for years. Failure to recognize the rare signs and symptoms of hypothyroidism leads to unnecessary morbidity and rarely, even to death, from myxedema coma. We discuss a number of cases which presented over the past few years with less recognized symptoms, such as convulsions, acute psychosis, neuromuscular disturbances and deafness. Other atypical presenting symptoms that have been described include intestinal pseudo-obstruction and bleeding disorders. One should be aware of these varied presentations of hypothyroidism.