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Weight gain, fatigue, cold intolerance — hypothyroidism; TSH high, levothyroxine daily. Primary hypothyroidism (Hashimoto's autoimmune commonest — low T4, high TSH: fatigue, weight gain, cold intolerance, constipation, bradycardia): levothyroxine daily (empty stomach; titrate to TSH). Hyperthyroidism (Graves' — autoimmune, eye signs — proptosis, lid lag; toxic nodule: weight loss, tremor, palpitations, heat intolerance — low TSH, high T4): carbimazole + propranolol; radioiodine/surgery definitive. Storm (fever, tachycardia, agitation — PTU + iodine + steroids + cooling): emergency. Myxedema coma (hypothermia, coma — IV thyroxine + steroids): emergency. The TSH is the thermostat — high means the gland is failing.