Cite this post as:
Scott Weingart, MD FCCM. EMCrit 290 – Decompensated Hypothyroidism and Myxedema with Dr. Arti Bhan. EMCrit Blog. Published on January 23, 2021. Accessed on March 24th 2023. Available at [https://emcrit.org/emcrit/hypothyroidism-myxedema/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: January 23, 2021
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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One of our ED docs has recently added a FT4 without a TSH to the lab panel that he draws on delirious patients. I have found no support for this and argued that if they want to check anything, check a TSH with reflex T4 if the TSH is abnormal. Am I missing something? Enjoy the podcast
Secondary hypothyroidism can have a TSH that appears in normal range but will have low T4. TSH can also be slow to respond, for still unknown reasons, and if used alone can miss low T4. I’ve see patients with very low T4 and T3 and obvious hypothyroid symptoms still have a normal TSH, they improved with thyroid medication. Also, another patient with results showing hyperthyroidism with a TSH of 0.002 but severe clinical symptoms and history of hypothyroidism and temperature of 34C. They had an rT3 three times the normal limit indicating an excessively high deiodinase 3 (D3) enzyme level… Read more »
When we start treating it in the ED? Based on history and physical only is the possibility?