Thyroid disease in the emergency department. Thyroid function tests and hypothyroidism and myxedema coma

The recognition of hypothyroidism may not always be easy in the emergency department setting. Laboratory evaluations of thyroid function are not usually performed on a 24-hour basis, and therefore the emergency physician, although suspecting the presence of hypothyroidism, may be unable to confirm the diagnosis while the patient is in the Emergency Department. It is not always the responsibility of the emergency physician to diagnose hypothyroidism, but in some clinical settings it may be important to include thyroid function tests in laboratory evaluation of patients to ensure adequate patient care and followup. Careful attention to nonspecific complaints, myxedematous changes, and signs of dysfunction of any organ system, especially in older female patients, may lead to the ultimate correct diagnosis. Myxedema coma is potentially fatal and must be recognized and treated emergently, usually prior to laboratory confirmation. Ventilatory support and thyroid hormone replacement are the two most important therapeutic maneuvers in the treatment of myxedema coma.