Hypothyroidism: Diversity of Presentation HYPOTHYROIDISM is usually represented as having stereotyped, easily recognized signs and symptoms (1–4). Lethargy, constipation, cold intolerance, intellectual and motor dullness, dry skin, hoarse voice, slowed reflexes, and bradycardia are considered to be typical symptoms. Other features associated with the disease are usually given less emphasis. In our experience and that of others (5), the assumption that hypothyroidism has a typical presentation can be hazardous. Hypothyroidism is a common disease in adults. A recent survey (3) indicated that 1.4% of women (and 0.1% of men) are hypothyroid. This implies that appreciable numbers of patients may have uncommon symptoms overlooked by their physicians. One review of 400 cases (6) indicated that most of the above mentioned symptoms of hypothyroidism are present in only 25-70% of patients. Yet, most had some signs and symptoms, which if recognized as indicative of hypothyroidism, could have led to more prompt diagnosis and treatment. Also to be noted is that death from myxedema although uncommon does occur (7).