Ep 210 Decompensated Hypothyroidism Recognition and Management
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Dec 16, 2025 In this insightful discussion, Dr. George Willis, an expert in endocrine emergencies from the University of Texas, and Dr. Alyssa Lewis, a critical care specialist from Toronto, dive into the intricacies of decompensated hypothyroidism. They clarify why 'myxedema coma' is a misleading term and discuss crucial ways to differentiate it from sepsis and overdose. Topics include the importance of cortisol testing, risks associated with intubation, and strategies for effective management, emphasizing the critical need for early diagnosis and proper treatment in these complex cases.
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Replace 'Myxedema Coma' With A Better Term
- Abandon the term "myxedema coma" because it misleads bedside recognition.
- Use "decompensated hypothyroidism" to capture varied presentations and end-organ dysfunction.
Use T-SHIRT To Trigger Thyroid Tests
- Use the T-SHIRT mnemonic to trigger thyroid testing: temperature, strange vitals, heart rhythm, infection, respiratory issues, two-plus metabolic derangements.
- Lower threshold to test when multiple systems are acutely abnormal.
Use POCUS To Guide Resuscitation
- Use POCUS to look for pericardial effusion, low EF, IVC status and pleural effusions to guide fluids and pressors.
- Give small fluid boluses and prioritize pressors if EF is low or IVC is full.