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In UK 1.9% women and 0.1% men are hypothyroid while 15% F and 10% M are
sub-clinically hypothyroid
may have raised MCV with hypothyroid (remember alcohol, B12, folate)

''Investigations''
recheck bloods in 6-8/52 if sub-clinical
Thyroid peroxidase antibodies (TPO)
Baseline lipids and ECG (subclinical hypothyroid ? risk factor for CHD)
Coeliac serology

''Causes''
Chronic autoimmune - Hashimoto (most common) or atrophic thyroiditis (post De Quervains (subacute) thyroiditis - usually hyperthyroid initially (?painful thyroid with raised ESR), may then go hypothyroid
Postpartum thyroiditis - 15% pregnant women in 1st yr post partum - hyper and then hypo - need to stop thyroxine at one year and assess recovery
Iodine deficiency (commonest worldwide)
Infiltration eg Sarcoid or Haemochromatosis
Iatrogenic - post Rx for hyper - radioactive, surgery, neck radiotherapy
drugs - Lithium, Amiodarone

''refer if ....''
pregnant or under 16
secondary hypothyroid or subacute thyroiditis
Sx getting worse
Co-morbid eg CHD or on drugs

''Annually test''
Those on thyroxine
those who've had Rx for hyperthyroid or recieved neck irradiation
those on lithium, amiodarone
those with turners or downs or diabetes 
Test 3/12 till dose stable and 6-8/52 post dose change