Document Detail


Diagnosis of unrecognized primary overt hypothyroidism in the ED.
MedLine Citation:
PMID:  20887907     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (13 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 18 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.
Authors:
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
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Publication Detail:
Type:  Journal Article     Date:  2010-03-25
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  28     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-04     Completed Date:  2010-10-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  866-70     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Emergency Department, Taipei Veterans General Hospital, Taipei 112, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cardiomegaly / radiography
Diagnosis, Differential
Diagnostic Errors / statistics & numerical data
Emergency Service, Hospital / statistics & numerical data*
Female
Humans
Hypothyroidism / diagnosis*,  epidemiology,  etiology
Incidence
Male
Middle Aged
Myxedema / diagnosis
Pericardial Effusion / radiography
Retrospective Studies
Taiwan / epidemiology
Thyrotropin / blood
Chemical
Reg. No./Substance:
9002-71-5/Thyrotropin

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