A total of 304 patients aged 65 years or over were prospectively studied over a four-month period to assess whether clinical findings or routine screening were more helpful in diagnosing biochemical hypothyroidism. The most useful symptom relevant to a possible diagnosis of hypothyroidism in the elderly was found to be dry skin. Dermatological signs and certain ECG abnormalities (especially atrial fibrillation) were helpful when querying a diagnosis of hypothyroidism. Almost 50% of patients receiving amiodarone had abnormal thyroid function tests (TFTs). Routine screening for hypothyroidism does not seem justifiable from our available data although this conclusion may have been different had hospital clinicians and general practitioners followed their patients up more closely after an initial abnormal result was obtained.