الفهرس 
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Abstract
Hypothyroidism refers to the common pathological condition of thyroid hormone deficiency. If untreated, it can lead to serious adverse health effects and ultimately death. T4 replacement therapy is the standard treatment of HT that appears effective in restoring biochemical euthyroidism as evidenced by serum TSH, and fT4 and T3 levels within the normal values (Cooper and Biondi, 2012). Some of patients with hypothyroidism, mostly women, treated with an adequate dose of levothyroxine will report persistent symptoms, such as fatigue, depressed mood, and weight gain despite having a TSH level in the lower half of the normal range (Grozinsky-Glasberg et al., 2006). In addition, combination of T3/T4 therapy, in the form of levothyroxine plus liothyronine, versus T4 monotherapy showed no improvements in bodily pain, depression, or quality of life (Grozinsky-Glasberg et al., 2006).This study was conducted to evaluate why some of hypothyroid patients on levothyroxine Treatment continue to have residual symptoms despite apparently adequate replacement and laboratory euthyroid status and involved 111 cases of hypothyroid patients, who were divided into 2 groups according to presence or absence of most frequent symptoms of hypothyroidism group (1) included 90 patients diagnosed as primary hypothyroidism with persistent symptoms despite normal TSH level. group (2) included 21hypothyroid patients, which are clinically free from symptoms of hypothyroidism with normal TSH level. All cases were subjected to through history taking, general and local examination focusing on symptoms of hypothyroidism before and after treatment for six months, Laboratory investigation (Free T3 (Free triiodothyronine), Free T4 (Free thyroxine hormone), TSH (thyroid stimulating hormone), TPO Abs (anti-thyroid peroxidase antibodies)& Vit.D level.