The many faces of hypothyroidism: a review of two inpatient populations

Unusual presentations of acute hypothyroidism often go unrecognized and delay the onset of effective therapy. We reviewed admissions of two different patient populations at the University of Louisville Hospital and the Veterans Affairs Medical Center to evaluate the extent and profiles of such patients admitted for acute care. We found that although these hospitals differed in gender and age profiles, similarities existed for their admissions and delay in diagnosis for hypothyroidism. These similarities were related to unusual clinical presentation including myxedematous states, which were not usually recognized, and psychiatric conditions that were also commonly complicated by hypothyroidism. In all cases, the history, physical examinations, and thyroid-stimulating hormone test were essential in recognizing acute hypothyroidism so as to institute effective therapy with thyroid replacement early in the course of the disorder.