text_1: I saw a 54-year-old woman a year ago with severe dyspnea (dying), skin like leather and she was hypothyroid (thyroid stimulating hormone 400, T4 0, T3 0).  What happened to her thyroid, why did she get hypothyroid?
text_2: 54-year-old female, dyspnea, skin like leather, hypothyroid, thyroid stimulating hormone 400.  Why hypothyroid?