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The early changes in hypothyroidism are subtle and can be misdiagnosed especially if only a single symptom is dominant. Hence the list of conditions from which it has to be differentiated from is endless. To mention a few, anovulations, infertility, depression, chronic fatigue syndrome, sleep apnoea etc. Lack of early treatment leads to disease progression with gradual worsening of the symptoms and further metabolic derangements can occur. Estimation of the TSH levels is the single most sensitive index of thyroid function
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