Hypothyroidism is also associated with decreased bowel motility, tendency to gain weight, and cold intolerance, which are present in this patient. Some forms of hypothyroidism have a familial association.
The physical exam, including the relatively slow resting heart rate, the characteristic facies, and the delayed relaxation phase of the deep tendon reflexes is characteristic of hypothyroidism. The description of a firm, bosselated (bumpy) thyroid that is minimally enlarged raises the possibility of thyroiditis and is particularly characteristic of Hashimoto's thyroiditis.