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Hypothyroidism, Emergency Medicine

Rita K. Cydulka and Tammy L. Weiner Reviewed 06/2017



  • Decreased level of effective circulating thyroid hormone leads to decreased metabolic rate and decreased sensitivity to catecholamines.

  • More common in woman and the elderly

  • Myxedema co...


Signs and Symptoms


  • Exhaustion

  • Cold intolerance

  • Headaches

  • Diminished hearing

  • Myalgias and muscle weakness

  • Menorrhagia

  • Infertility

  • Carpal tunnel syndrome

  • Constipation

  • Weight gain

  • Depression, hallu...


Initial Stabilization/Therapy

  • ABCs:

    • Intubation and ventilation may be necessary

  • Cardiac monitor

  • Blood pressure support

  • Supplemental oxygen to meet metabolic needs

  • Correct hypothermia:

    • Initiate pass...



Admission Criteria

All patients with myxedema coma require ICU admission. 

Discharge Criteria

Hypothyroidism is managed in the outpatient setting. 

Issues for Referral

  • Primary care pro...

Pearls and Pitfalls

  • Signs and symptoms of hypothyroidism are nonspecific and may be confused with other mental or physical disorders.

  • Response to treatment for hypothyroidism may take weeks and is best...

Additional Reading

  • Brent  GA, Davies  TF. Hypothyroidism and thyroiditis. In: Melmed  S, Polonsky  KS, Larsen  PR, et al. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Else...



  • 243 Congenital hypothyroidism

  • 244.8 Other specified acquired hypothyroidism

  • 244.9 Unspecified acquired hypothyroidism

  • 244.0 Postsurgical hypothyroidism

  • 244.1 Other postablative hypothyroidism

  • 244...

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