Most common presentation

• Altered mental status
• Hypothermia
• Precipitating event
• **Myxedema and coma do not have to be present**

Physical exam findings

• Hypothermia
• Bradycardia
• Hypotension
• Cool skin
• Diffuse soft tissue swelling without pitting
• Altered mental status

Lab abnormalities

• Hyponatremia
• Elevated CK
• Elevated transaminases
• Hypoglycemia
• Elevated TSH with frankly low T4 level

Treatment

• IV levothyroxine
• Use of T3 is controversial
• Stress dose steroids because of concern for precipitating adrenal insufficiency
• Supportive measures