Hypothyroidism: A Case of Successful Treatment in a Young Man

A 35-year-old man presented to Clinic with complaints of pronounced weakness in his arms and legs and swelling all over his body.

The patient explained that due to weakness, he couldn’t hold tools in his hands, although the symptoms in the calf muscles were not as intense. He also experienced drowsiness (could fall asleep anywhere in any position). Over the past 5 years, he noticed a significant weight gain.

The main symptoms were accompanied by dry skin, peeling on the hands, constipation, and excessive thirst (drinking up to 3 liters of water per day on average).

The patient did not notice any factors that relieved his condition.


Intermittent weakness first appeared more than 5 years ago when the man began to feel tired after workouts at the gym. That’s when the weight gain started. Gradually, he stopped going to the gym. He struggled to perform his duties at work but did not seek medical help.

About 3 months before seeking medical attention, he developed swelling, which worsened over time, along with increased weakness and drowsiness.

The man works as a car mechanic. He eats irregularly, mainly consuming fast food and sugary drinks. He smokes and drinks alcohol once a week.

As a child and teenager, he had chronic gastritis.

The patient’s grandmother suffered from thyroid gland disease.


The man weighed 170 kg with a height of 175 cm. Body mass index (BMI) was 55.5 (class III obesity). Upon examination, pronounced skin dryness was observed, especially on the hands (hyperkeratosis). Hyperpigmentation was noted in the armpits and neck folds, while the abdomen had pale-pink wavy stripes of varying widths.

The thyroid gland was not visually identifiable but was palpable, enlarged, heterogeneous, and firm. Peripheral lymph nodes were of normal size.

Lung auscultation revealed normal breathing without crackles. Heart sounds were muffled with a regular rhythm. Heart boundaries were not enlarged. Blood pressure was 150/90 mmHg, heart rate was 65 beats per minute.

The abdomen was enlarged due to subcutaneous fat. Waist circumference was 160 cm. The abdomen was soft and non-tender. Bowel movements and urination were normal.

A glucometer showed normal blood glucose levels (5.2 mmol/L), while the level of thyrotropin hormone (TSH) was significantly elevated (110 mIU/mL).

ECG revealed abnormalities in the repolarization processes of the left ventricular myocardium.


Manifest hypothyroidism. Myxedema (extreme form of hypothyroidism). Presumably adrenal insufficiency.


To hospitalize the patient, emergency medical assistance was called.

After treatment in the endocrinology department of the City Clinical Hospital, the man noted a significant increase in muscle strength, reduction in edema, and drowsiness.

He was diagnosed with primary manifest hypothyroidism resulting from chronic autoimmune thyroiditis. Upon discharge, the patient was prescribed replacement therapy – L-Thyroxine at 150 mcg per day.

At the follow-up appointment after 3 months, the man reported a weight loss of 15 kg, disappearance of edema, dry skin, and hyperpigmentation. He resumed exercising at the gym and no longer had problems at work. The TSH level decreased to 50 mIU/mL.


This clinical case highlights the importance of differential diagnosis of hypothyroidism, adrenal insufficiency, and obesity. It is also noteworthy that hypothyroidism developed at a relatively young age, and the man sought help in a state of decompensation when the body could no longer adapt to the emerging health problem.