What is it?

• Severe hypothyroidism leading to AMS and hypothermia
• Can have other symptoms related to the slowing down of organs

Who gets it?

• Usually older females with long standing hypothyroidism triggered by a precipitating event

How does it present?

• Change in mental status (rarely presents as true overt coma)
• Hypothermia
• Hypotension
• Bradycardia
• Hyponatremia
• Hypoglycemia
• Hypoventilation

What labs should you check?

• TSH, FT4
• Cortisol (to rule out concurrent adrenal insufficiency)

What is the treatment?

• IV T3 and/or T4 – data is mixed
  • Use IV because patient likely has gut edema so PO form may have decreased absorption
  • T3 has better bioavailability and is the active form
  • In acute illness, body’s normal conversion of T4 to T3 is impaired
  • Monitor patients on telemetry because biggest concern is arrhythmias
  • Use lower dosing in elderly patients or those with cardiac disease
  • Recheck TSH in one week – goal is drop by > 50%
• Stress dose steroids (hydrocortisone 100 mg every 8 hours)
  • Until you rule out concomitant adrenal insufficiency
• Supportive measures
  • Avoid dilute fluids which can worsen hyponatremia
  • Use passive rewarming
  • Pressors if needed