Introduction Hypothyroidism is the second most frequent endocrine problem for older people and mainly women. Many of the signs and symptoms of hypothyroidism in older persons and women are blunted in their presentation, or the presentation is atypical, or the presentation may be dismissed as a normal reaction to aging. Although laboratory tests are remarkably improved in reliability, they still can pose difficulties in reaching a firm diagnosis. According to statistical results, about 15 million Americans suffer from hypothyroidism (American Medical Women’s Association 2007). Hypothyroidism is more often among women than men because of histological and biological differences. Prevalence The prevalence of hypothyroidism varies depending on ethnicity, the iodine content of the diet, and the criteria used to define the diagnosis. In the United States prevalence of hypothyroidism, as determined by elevated thyroid-stimulating hormone (TSH), varies from 4.4% to 7.3% in healthy adults above 55 years of age. High TSH is more prevalent in Caucasians than African-Americans (8.8% vs. 5.8%), in women than men (5.95 % to 8.5% vs. 2.3% to 4.4%), and in subjects older than 75 years of age. In America, 1 out of 5 women 75 years + have Hashimoto’s thyroiditis which can cause hypothyroidism (Mead, 2004; American Medical Women’s Association 2007). Causes Hypothyroidism is a systemic disorder that results in the decreased secretion of thyroid hormones because of loss of functional cells and metabolic changes. Signs and symptoms of this disorder vary with the severity of the disease. These include lethargy, weakness, dry atrophic skin, poor memory, constipation, and intolerance to cold (Renner, 2003). The first subtle presentation of Hypothyroidism in elderly women may be mild psychic disturbances such as withdrawal, depression, and mild forms of dementia (Blount et al 2006). Other atypical signs and symptoms such as fecal impaction, elevations in plasma, cholesterol, or triglycerides, macrocytic anemia, and congestive heart failure may be clinical indications of Hypothyroidism in the older adult. The aged adult may also develop incontinence, decreased mobility, and falls. There are a number of causes of hypothyroidism, but the most common is the idiopathic atrophy of the gland. This thyroid gland failure is found more frequently in patients above the age of 50 years and deserves special consideration. At present, idiopathic atrophy is poorly understood. Significant decline in triiodothyronine (T 3 ) occurs with age, which is thought to reflect the reduced conversion of T 4 to T 3 in extrathyroidal locations. Collective signs, such as a slowed basal metabolic rate, thinning of the hair, and dry skin are characteristic of hypothyroidism in the young but are normal manifestations in the aged who have no history of thyroid deficiencies (Brown, 2003; Scinicariello et al 2995). According to Renner (2003): “thyroid hormone receptors, in the absence of thyroid hormone, repress gene expression. In the presence of thyroid hormone, the receptors activate gene expression. When there are no receptors, the genes are expressed at an intermediate baseline level” (p. 25). Some of the aged do develop hypothyroidism and should be evaluated. This is one instance in which it is difficult, on the surface, to establi