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Other problems include the following: large scale and fine motor skills and coordination, reduced muscle tone, squinting, decreased attention span, and delayed speaking.In older children and adolescents, the symptoms of hypothyroidism may include fatigue, cold intolerance, sleepiness, muscle weakness, constipation, a delay in growth, overweight for height, pallor, coarse and thick skin, increased body hair, irregular menstrual cycles in girls, and delayed puberty.

Thyroxine levels decrease TRH and TSH production by a negative feedback process.The thyroid gland is the only source of thyroid hormone in the body; the process requires iodine and the amino acid tyrosine.The gland is increased in size by 10%, thyroxine production is increased by 50%, and iodine requirements are increased.Many women have normal thyroid function but have immunological evidence of thyroid autoimmunity (as evidenced by autoantibodies) or are iodine deficient, and develop evidence of hypothyroidism before or after giving birth.Less common causes include: previous treatment with radioactive iodine, injury to the hypothalamus or the anterior pituitary gland, certain medications, a lack of a functioning thyroid at birth, or previous thyroid surgery.

People with hypothyroidism often have no or only mild symptoms.Signs may include delayed relaxation of the ankle reflex and a slow heart beat.Hypothyroidism is caused by inadequate function of the gland itself (primary hypothyroidism), inadequate stimulation by thyroid-stimulating hormone from the pituitary gland (secondary hypothyroidism), or inadequate release of thyrotropin-releasing hormone from the brain's hypothalamus (tertiary hypothyroidism). It is characterized by infiltration of the thyroid gland with T lymphocytes and autoantibodies against specific thyroid antigens such as thyroid peroxidase, thyroglobulin and the TSH receptor.Not enough iodine, or not enough TSH, can result in decreased production of thyroid hormones.The hypothalamic–pituitary–thyroid axis plays a key role in maintaining thyroid hormone levels within normal limits.The hypothalamus secretes TRH (green), which stimulates the production of TSH (red) by the pituitary gland.