Ep 210 Decompensated Hypothyroidism Recognition and Management

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 16 December 2025

⏱️ 72 minutes

🔗️ Recording | iTunes | RSS

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Summary

In the ED, we regularly care for sick patients presenting acutely with abnormal vital signs, altered mental status, and end organ dysfunction. Oftentimes, the culprit ends up being sepsis, or overdose, or organ failure. But it is important that we consider rarer endocrine presentations like decompensated hypothyroidism. In this Part 1 of this two-part podcast with Dr George Willis and Dr Alyssa Louis, we answer questions like: Why is the term myxedema coma a misnomer and should be abandoned? How can we differentiate between sepsis or environmental hypothermia or toxidrome from decompensated hypothyroidism at the bedside? When is it appropriate to order a TSH, a T4 and T3? What are the most important life-threatening triggers that need to be addressed in patients with decompensated hypothyroidism? Why is it important to test for cortisol levels and consider stress-dose steroids in all patients with decompensated hypothyroidism? Why is endotracheal intubation particularly dangerous in decompensated hypothyroidsm? What is the best way to manage hypothermia? Why is the order of medications for treatment of decompensated hypothyroidism so important? and many more... Please consider a donation to EM Cases to ensure continuing Free Open Access Medical Education: https://emergencymedicinecases.com/donation/

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman, bringing you the brightest minds in emergency medicine from around the world. EMCases is brought to you by Shremi, the Schwartz-Riesman Emergency Medicine Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or, or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physicians.
0:24.3	First, just a quick word from our sponsor Metricade, the experts in complex physician scheduling since 2012.
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1:03.2	EMC-A-S-E-S. This episode is brought to you by Easy Recess, the Resuscitation Assistant.
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1:34.6	Let's see you've got an older patient in your resuscitation bay. They're altered,
1:39.0	they're cold, and they're bradicardic. Maybe the sodium's low. You're thinking sepsis,
1:45.9	maybe environmental hypothermia,
1:52.7	maybe even acedentive overdose. But what if you're missing the real killer? Or maybe it's the other end of the spectrum. You've got a patient who's febrile, tachycardic, who's in rapid
1:58.3	a fib, who looks kind of septic, but isn't septic.
2:02.8	These are the zebras that can gallop right past you if you're not tuned in to thyroid
2:07.7	emergencies.
2:09.2	In this two-part EM cases episode, with the help of doctors George Willis and Dr. Alyssa
2:14.7	Lewis, we'll cover both extremes, mixadema coma and thyroid storm,
	...

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