Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:54

804 Hypothyroidism Ichthyosis

■Hydrocortisone: use if secondary hypothyroidism or myxedema

coma present

■Avoid excessive sedative drugs and fluids to decrease possibility of

hyponatremia and coma

■Passive warming if hypothermia present

follow-up

During Treatment

■Assess thyroid status q 6–8 wks by clinical exam and serum free T4

or TSH

Routine

■Annual assessment of thyroid status with free T4 or TSH

complications and prognosis

Complications

■Myxedema coma: rare and requires intensive care

■Ischemic heart disease may be worsened by levothyroxine

■Levothyroxine alone may precipitate adrenal crisis in sec-

ondary hypothyroidism if concomitant secondary hypoadrenalism

present

■Hyponatremia may result from poor free water clearance

Prognosis

■Myxedema coma: up to 50% mortality

■Euthyroid state easily achieved except when ischemic heart disease

present

Ichthyosis..........................................

MOISE L. LEVY, MD

history & physical

History

■Onset in adulthood – ichthyosis with onset in childhood is generally

an entirely different disorder (see differential diagnosis)

■Acquired ichthyosis is commonly a cutaneous marker for various

chronic and malignant diseases, so history of concomitant disorder

should be elicited

➣Common malignancies associated with acquired ichthyosis