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Critically ill severe hypothyroidism: a retrospective multicenter cohort study.

Simon Bourcier1, Maxime Coutrot1, Alexis Ferré2

  • 1Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France.

Annals of Intensive Care
|March 9, 2023
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Summary

Severe hypothyroidism (SH) is a rare endocrine emergency. Early diagnosis and rapid levothyroxine treatment are crucial for improving outcomes in critically ill patients.

Keywords:
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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.