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Symptoms of hypothyroidism vary depending on the severity of the hormone deficiency, but may include: Fatigue Sensitivity to cold, feeling cold when others do not Pale, dry skin Constipation Weight gain Puffy face Hoarse voice Heavy or irregular menstrual periods Thinning hair Slow heart rate Depression Impaired memory Muscle weakness Elevated blood cholesterol level Muscle aches, tenderness and stiffness Pain or stiffness in joints Causes of Hypothyroidism Hypothyroidism can result from a number of factors, including: Autoimmune disease : Autoimmune disorders cause the immune system to produce antibodies that attack the body’s own tissues

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As it has been reported, the prevalence of melasma is much higher in the Middle East and South East Asians, Hispanic Americans, Mediterranean Africans, and also Brazilian (Majid and Aleem, 2021)

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