Hypothyroidism is a topic covered in the 5-Minute Emergency Consult.

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  • 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 coma is a rare, extreme form of hypothyroidism characterized by altered mental status and defective thermoregulation triggered by a precipitating event in a patient with hypothyroidism.


  • Primary:
    • Idiopathic
    • Congenital
    • Autoimmune:
      • Thyroiditis
      • Hashimoto disease
    • Iatrogenic:
      • Postsurgical
      • External radiation
      • Radioiodine therapy
      • Drugs (iodides, lithium, amiodarone, sunitinib, bexarotene, interferons, narcotics, sedatives)
    • Neoplasm: Primary (carcinoma) or secondary (infiltration)
    • Infection: Viral (rarely aerobic or anaerobic bacteria)
    • Iodine deficiency (most common cause worldwide)
  • Central (very rare):
    • Pituitary or hypothalamic disorder induced by drugs or severe illness
    • May have other associated hormone deficiencies
  • Myxedema coma:
    • Critical decompensation of a patient with hypothyroidism due to a stress, often during winter months. Stressors include:
      • Infection
      • Hypothermia
      • Intoxication
      • Drugs
      • Cerebrovascular accident
      • Heart failure
      • Trauma

Pregnancy Considerations
  • Hypothyroid women require increased exogenous thyroid hormone replacement during pregnancy above baseline
  • Postpartum thyroiditis occurs in up to 10% of women:
    • Usually 3–6 mo postpartum
    • Typically resolves without treatment

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