Diagnosis of unrecognized primary overt hypothyroidism in the ED

Ying Ju Chen, Sen Kuang Hou, Chorng Kuang How, Chii Hwa Chern, Hong Chang Lo, David Hung Tsang Yen, Chun I. Huang, Chen Hsen Lee

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: The aims of the study were to evaluate the incidence of newly diagnosed primary overt hypothyroidism among adults admitted through the emergency department (ED) and to assess how previously undiagnosed hypothyroidism presents. Methods: From July 1, 2002 to June 30, 2006, 56 adult patients were enrolled for further analysis. Results: The incidence of newly diagnosed primary overt hypothyroidism among adults admitted through the ED is 0.1%. The mean age of the patients was 75.8 ± 12.8 years (range, 27-98 years). Most of our patients presented in the winter. Individual symptoms and signs were not sensitive. Drugs (13A patients, 23%), nongoitrogenous autoimmune thyroiditis (12 patients, 21%), and previous surgery or irradiation related (11 patients, 20%) are frequent causes of unrecognized hypothyroidism in this iodine-replete region. Only 21% of patients were admitted with a correct initial impression. Half of myxedema coma patients were missed during the initial ED stay. Thirty-three patients (59%) had cardiomegaly on chest x-ray receiving further echocardiography examination. Pericardial effusion was found in 18A patients. Of these, 7 patients had moderate to large pericardial effusion, but none had cardiac tamponade. Only 6 patients have depressed left ventricular ejection fraction (<40%). Conclusions: The diagnosis of hypothyroidism is often missed during the ED evaluation of patients at risk for this uncommon disease. Hypothyroidism should always be considered in patients who present with nonspecific symptoms suggestive of the disease, including weakness, cold intolerance, and alterations in mental status, and receive drugs impairing thyroid function or treatment of advanced head and neck cancer. In addition, patients with stable chronic heart failure or unexplained pericardial effusion warrant serum thyroid testing.

Original languageEnglish
Pages (from-to)866-870
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume28
Issue number8
DOIs
Publication statusPublished - Jan 1 2010
Externally publishedYes

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Hypothyroidism
Hospital Emergency Service
Pericardial Effusion
Thyroid Gland
Myxedema
Autoimmune Thyroiditis
Cardiac Tamponade
Incidence
Cardiomegaly
Head and Neck Neoplasms
Coma
Iodine
Pharmaceutical Preparations
Stroke Volume
Signs and Symptoms
Echocardiography
Thorax
Heart Failure

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Chen, Y. J., Hou, S. K., How, C. K., Chern, C. H., Lo, H. C., Yen, D. H. T., ... Lee, C. H. (2010). Diagnosis of unrecognized primary overt hypothyroidism in the ED. American Journal of Emergency Medicine, 28(8), 866-870. https://doi.org/10.1016/j.ajem.2009.04.024

Diagnosis of unrecognized primary overt hypothyroidism in the ED. / Chen, Ying Ju; Hou, Sen Kuang; How, Chorng Kuang; Chern, Chii Hwa; Lo, Hong Chang; Yen, David Hung Tsang; Huang, Chun I.; Lee, Chen Hsen.

In: American Journal of Emergency Medicine, Vol. 28, No. 8, 01.01.2010, p. 866-870.

Research output: Contribution to journalArticle

Chen, YJ, Hou, SK, How, CK, Chern, CH, Lo, HC, Yen, DHT, Huang, CI & Lee, CH 2010, 'Diagnosis of unrecognized primary overt hypothyroidism in the ED', American Journal of Emergency Medicine, vol. 28, no. 8, pp. 866-870. https://doi.org/10.1016/j.ajem.2009.04.024
Chen, Ying Ju ; Hou, Sen Kuang ; How, Chorng Kuang ; Chern, Chii Hwa ; Lo, Hong Chang ; Yen, David Hung Tsang ; Huang, Chun I. ; Lee, Chen Hsen. / Diagnosis of unrecognized primary overt hypothyroidism in the ED. In: American Journal of Emergency Medicine. 2010 ; Vol. 28, No. 8. pp. 866-870.
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abstract = "Objective: The aims of the study were to evaluate the incidence of newly diagnosed primary overt hypothyroidism among adults admitted through the emergency department (ED) and to assess how previously undiagnosed hypothyroidism presents. Methods: From July 1, 2002 to June 30, 2006, 56 adult patients were enrolled for further analysis. Results: The incidence of newly diagnosed primary overt hypothyroidism among adults admitted through the ED is 0.1{\%}. The mean age of the patients was 75.8 ± 12.8 years (range, 27-98 years). Most of our patients presented in the winter. Individual symptoms and signs were not sensitive. Drugs (13A patients, 23{\%}), nongoitrogenous autoimmune thyroiditis (12 patients, 21{\%}), and previous surgery or irradiation related (11 patients, 20{\%}) are frequent causes of unrecognized hypothyroidism in this iodine-replete region. Only 21{\%} of patients were admitted with a correct initial impression. Half of myxedema coma patients were missed during the initial ED stay. Thirty-three patients (59{\%}) had cardiomegaly on chest x-ray receiving further echocardiography examination. Pericardial effusion was found in 18A patients. Of these, 7 patients had moderate to large pericardial effusion, but none had cardiac tamponade. Only 6 patients have depressed left ventricular ejection fraction (<40{\%}). Conclusions: The diagnosis of hypothyroidism is often missed during the ED evaluation of patients at risk for this uncommon disease. Hypothyroidism should always be considered in patients who present with nonspecific symptoms suggestive of the disease, including weakness, cold intolerance, and alterations in mental status, and receive drugs impairing thyroid function or treatment of advanced head and neck cancer. In addition, patients with stable chronic heart failure or unexplained pericardial effusion warrant serum thyroid testing.",
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