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)
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