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■ Iodine deficiency

■ Antithyroid drugs such as lithium, amiodarone, iodine and iodinated

contrast, sulfonamides, or phenylbutazone

■ Spontaneous hypothyroidism from Graves

■ Congenital

■ 2 °hypothyroidism

■ Pituitary tumors

■ Postpartum hemorrhage: Sheehan syndrome

■ Sarcoidosis

■ Hypothalamic dysfunction: Tertiary hypothyroidism

SYMPTOMS

■ Fatigue, lethargy, coma in extreme cases

■ Weakness

■ Cold intolerance

■ Weight gain

■ Menstrual irregularity

■ Muscle cramps

■ Thinning hair or hair loss

■ Urinary retention

EXAM

■ Hypothermia

■ Respiratory failure

■ Cardiovascular findings

■ Bradycardia and hypotension

■ Cardiomegaly

■ Low voltage 2°to pericardial effusion

■ Prolonged QT

■ Dry skin and thinning hair

■ Abdominal distention

■ Nonpitting edema

■ Cheyney reflexes (brisk upstroke but delayed relaxation)

DIAGNOSIS

■ TSH, FT4 can confirm diagnosis and indicate type of disorder.

■ Glucose: Normal to low

■ Electrolytes: Hyponatremia and hypochloremia (hypocalcemia in thy-

roidectomy patients)

■ CBC: Left shift

■ Elevated serum cholesterol, CPK, LDH, and AST sometimes found

■ Elevated protein >100 mg/dL in CSF

TREATMENT

■ Thyroid hormone: 300–500 μg IV thyroxine

■ Supportive

■ Correction of electrolytes, blood glucose, hypothermia, and respiratory

support

■ Antibiotics if underlying infection

ENDOCRINE, METABOLIC, FLUID, AND

ELECTROLYTE DISORDERS