Medicine
Omar A. Hassan; Behzad Nazari
Abstract
Introduction: The current American Thyroid Association (ATA) recommendations support the intravenous administration of a loading dose of levothyroxine and an empiric glucocorticoid as part of the initial therapy despite the lack of adequate evidence. SH may ultimately direct patients to the intensive ...
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Introduction: The current American Thyroid Association (ATA) recommendations support the intravenous administration of a loading dose of levothyroxine and an empiric glucocorticoid as part of the initial therapy despite the lack of adequate evidence. SH may ultimately direct patients to the intensive care unit (ICU) for organ support and specialized care. Material and Methods: The following baseline data were available at the time of ICU admission: demographics, the modified Charlson score, the Simplified Acute Physiology Score II (SAPS II), the SOFA score, the presence of an underlying thyroid condition, precipitating factors, clinical symptoms, and laboratory results. Results: Cardiovascular SOFA =2 patients had lower heart rates, higher arterial lactate, and a higher risk of aspiration pneumonia and cardiac arrest prior to ICU admission than those without hemodynamic impairment. Conversely, patients who did not have cardiovascular failure experienced hypercapnia more frequently. In the population as a whole with SH, the median TSH, FT4, and FT3 levels were 51pmol/L, respectively. Notably, there were no differences in thyroid hormone levels, SH etiology, or triggers between patients with and without hemodynamic impairment.Conclusion: The overall ICU and 6-month post-admission mortality rates were 26% and 39%, respectively, based on 82 patients with SH admitted to ICUs. Age, hemodynamic and respiratory failure, but not neurological failure, were factors that were strongly linked to fatal outcomes. This extremely high mortality for a treatable condition necessitates early diagnosis, prompt levothyroxine administration, and careful cardiac and hemodynamic monitoring. More information is still required to more precisely define the ideal dosage and route of administration for this critical treatment.
