If you Google, (or any other search, for that matter) "symptoms of hypothyroidism", amongst the most common are fatigue (tiredness), weight gain, and hair loss (alopecia). It would be reasonable to check a TSH in this setting.
Other symptoms such as changes in skin texture (usually increase in dryness), constipation, bad menstrual cramping (dysmenorrhea), muscle aching (myopathy)
As the most common cause of hypothyroidism is autoimmune, other autoimmune gland problems such as Addison's disease (autoimmune adrenal insufficiency), Type 1 Diabetes Mellitus (autoimmune destruction of pancreatic islet cells), and vitiligo (autoimmune destruction of the pigment-producing cells in the skin) should also trigger routine laboratory evaluation for TSH.
Medical conditions, such as congestive heart failure, dementia (confusion) anemia (low blood count) without specific cause, high cholesterol (hyperlipidemia), or an abnormal heart rhythm (cardiac dysrhythmia, prolonged QT interval on EKG) can also be associated with hypothyroidism.
Other reasons to check? I think of family history in a first degree relative (parent, sibling, child), as well as pregnancy. In a child, triggers to check also include poor growth, or, actually, remarkable improvement in school performance, as hypothyroiid kids sit still and pay attention, go figure!
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