Critically ill severe hypothyroidism: a retrospective multicenter cohort study

Area of Science:

• Endocrinology
• Critical Care Medicine

Background:

• Severe hypothyroidism (SH) is a rare, life-threatening endocrine emergency.
• Limited data exist on the management and outcomes of severe SH requiring intensive care unit (ICU) admission.

Purpose of the Study:

• To describe clinical manifestations, management strategies, and in-ICU and 6-month survival rates for patients with severe hypothyroidism admitted to the ICU.

Main Methods:

• Retrospective, multicenter study over 18 years in 32 French ICUs.
• Inclusion criteria: biological hypothyroidism with at least one cardinal sign (altered consciousness, hypothermia, circulatory failure) and SH-related organ failure.
• Data screened from medical records using ICD-10.

Main Results:

• Eighty-two patients included. Main etiologies: thyroiditis (29%) and thyroidectomy (19%). Unknown hypothyroidism in 54% prior to ICU admission.
• Common triggers: levothyroxine discontinuation (28%), sepsis (15%), amiodarone (11%). Presentations: hypothermia (66%), hemodynamic failure (57%), coma (52%).
• In-ICU mortality: 26%; 6-month mortality: 39%. Independent predictors of in-ICU mortality: age >70, SOFA cardiovascular score ≥2, SOFA ventilation score ≥2.

Conclusions:

• Severe hypothyroidism is a rare, life-threatening emergency with diverse presentations.
• Hemodynamic and respiratory failures are significant predictors of poor outcomes.
• High mortality necessitates early diagnosis, prompt levothyroxine administration, and vigilant cardiac/hemodynamic monitoring.