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. 2023 Mar 9;13(1):15.
doi: 10.1186/s13613-023-01112-1.

Critically ill severe hypothyroidism: a retrospective multicenter cohort study

Simon Bourcier  1 , Maxime Coutrot  1 , Alexis Ferré  2 , Nicolas Van Grunderbeeck  3 , Julien Charpentier  4 , Sami Hraiech  5 , Elie Azoulay  6 , Saad Nseir  7   8 , Nadia Aissaoui  9 , Jonathan Messika  10 , Pierre Fillatre  11 , Romain Persichini  12 , Serge Carreira  13 , Alexandre Lautrette  14 , Clément Delmas  15   16 , Nicolas Terzi  17 , Bruno Mégarbane  18 , Jean-Baptiste Lascarrou  19 , Keyvan Razazi  20 , Xavier Repessé  21 , Claire Pichereau  22 , Damien Contou  23 , Aurélien Frérou  24 , François Barbier  25 , Stephan Ehrmann  26   27   28 , Etienne de Montmollin  29 , Benjamin Sztrymf  30 , Elise Morawiec  31 , Naïke Bigé  32 , Danielle Reuter  33 , David Schnell  34 , Olivier Ellrodt  35 , Jean Dellamonica  36 , Alain Combes  1   37 , Matthieu Schmidt  38   39
Affiliations

Critically ill severe hypothyroidism: a retrospective multicenter cohort study

Simon Bourcier et al. Ann Intensive Care. .

Abstract

Background: Severe hypothyroidism (SH) is a rare but life-threatening endocrine emergency. Only a few data are available on its management and outcomes of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management, and in-ICU and 6-month survival rates of these patients.

Methods: We conducted a retrospective, multicenter study over 18 years in 32 French ICUs. The local medical records of patients from each participating ICU were screened using the International Classification of Disease 10th revision. Inclusion criteria were the presence of biological hypothyroidism associated with at least one cardinal sign among alteration of consciousness, hypothermia and circulatory failure, and at least one SH-related organ failure.

Results: Eighty-two patients were included in the study. Thyroiditis and thyroidectomy represented the main SH etiologies (29% and 19%, respectively), while hypothyroidism was unknown in 44 patients (54%) before ICU admission. The most frequent SH triggers were levothyroxine discontinuation (28%), sepsis (15%), and amiodarone-related hypothyroidism (11%). Clinical presentations included hypothermia (66%), hemodynamic failure (57%), and coma (52%). In-ICU and 6-month mortality rates were 26% and 39%, respectively. Multivariable analyses retained age > 70 years [odds ratio OR 6.01 (1.75-24.1)] Sequential Organ-Failure Assessment score cardiovascular component ≥ 2 [OR 11.1 (2.47-84.2)] and ventilation component ≥ 2 [OR 4.52 (1.27-18.6)] as being independently associated with in-ICU mortality.

Conclusions: SH is a rare life-threatening emergency with various clinical presentations. Hemodynamic and respiratory failures are strongly associated with worse outcomes. The very high mortality prompts early diagnosis and rapid levothyroxine administration with close cardiac and hemodynamic monitoring.

Keywords: Cardiogenic shock; Coma; Critical care; Hypothyroidism; Myxedema.

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Conflict of interest statement

Outside the submitted work: NB has received lecturer fees from Sanofi; AC has received lecturer fees from Getinge, Baxter and Xenios; SE has received grants from Aerogen LTD, Fisher and Paykel Healthcare, consulting fees from Aerogen LTD, and lecturer fees from Aerogen LTD and Fisher and Paykel Healthcare; AF has received honoraria for a lecture during SFMU Congress 2022 (Paris, France) from Fisher and Paykel; MS has received lecturer fees from Getinge, Drager, and Xenios; SN has received lecturer fees from MSD, Pfizer, Gilead, BioMérieux, Bio Rad and Fisher and Paykel. JM received congress reimbursment fees from CSL Behring and Biotest. None of the other authors have any competing interests to disclose.

Figures

Fig. 1
Fig. 1
Main clinical presentation of severe hypothyroidism in critically-ill patients
Fig. 2
Fig. 2
Six-month survival according to A age, B hypothermia, C hypoglycemia, D coma, E cardiovascular component of the SOFA score, and F ventilation component of the SOFA score
See this image and copyright information in PMC

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