Share This Article:

Overt Hypothyroidism in Hospitalized Patients: Clinical Characteristics

Abstract Full-Text HTML Download Download as PDF (Size:172KB) PP. 128-131
DOI: 10.4236/ojemd.2013.32019    3,189 Downloads   5,203 Views   Citations

ABSTRACT

Objectives: Hypothyroidism is usually detected in an outpatient setting, but might be diagnosed during hospitalization. The prevalent symptoms are not fully defined. This study aimed to determine the clinical characteristics of in-patients with overt hypothyroidism. Methods: The medical records of 23 inpatients (16F/7M, age 61.5 ± 21.8 years), who had 29 admissions with a primary diagnosis of hypothyroidism from January 1997 to December 2007 were retrospectively reviewed. They comprised 0.01% of all adult medical admissions during the study. Results: Fifty-five percent had a pre-admission diagnosis of hypothyroidism, 10% were nursing home residents and 38% had cognitive decline. Sixtynine percent presented with multiple complaints, mostly weakness and constipation, reported by 89% and 68%, respectively. Thyrotropin level was 74.3 ± 53.5 mIU/L (normal 0.23 - 4) and free thyroxine was 0.43 ± 0.29 ng/dL (normal 0.8 - 2). Elevated creatinine phosphokinase, anemia (hemoglobin < 12 g/dL) and hyponatremia (sodium < 135 mEq/L) were present in 89%, 62%, and 13%, respectively. Conclusions: Overt hypothyroidism during hospitalization occurs infrequently and mostly in patients with previously diagnosed hypothyroidism. Clinical manifestations include multiple non-specific symptoms, mainly weakness and constipation, while typical hypothyroid symptoms such as cold intolerance and weight gain are often overlooked. A high index of suspicion is needed to detect hypothyroidism in the hospital setting.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

P. Rotman-Pikielny, O. Borodin, R. Zissin and Y. Levy, "Overt Hypothyroidism in Hospitalized Patients: Clinical Characteristics," Open Journal of Endocrine and Metabolic Diseases, Vol. 3 No. 2, 2013, pp. 128-131. doi: 10.4236/ojemd.2013.32019.

References

[1] T. P. R. Larsen and T. F. Davies, “Hypothyroidism and Thyroiditis,” In: P. R. Larsen, H. M. Kronenberg, S. Melmed and K.S. Polonsky, Eds., Williams Textbook of Endocrinology, W.B. Saunders Company, Philadelphia, 2003, pp. 423-446.
[2] J. L. Jameson and A. P. Weetman, “Disorders of the Thyroid Gland,” In: S. F. Fauci, E. Braunwald, D. L. Kasper, et al., Eds., Harrison’s Principals of Internal Medicine, McGraw-Hill, New York, 2008, pp. 2229-2233.
[3] C. P. Roberts and P. W. Ladenson, “Hypothyroidism,” Lancet, Vol. 363, No. 9411, 2004, pp. 793-803. doi:10.1016/S0140-6736(04)15696-1
[4] E. H. Livingston, J. M. Hershman, C. T. Sawin and T. T. Yoshikawa, “Prevalence of Thyroid Disease and Abnormal Thyroid Tests in Older Hospitalized and Ambulatory Persons,” Journal of the American Geriatrics Society, Vol. 35, No. 2, 1987, pp. 109-114.
[5] M. Bahemuka and H. M. Hodkinson, “Screening for Hypothyroidism in Elderly Inpatients,” British Medical Journal, Vol. 2, No. 5971, 1975, pp. 601-603. doi:10.1136/bmj.2.5971.601
[6] J. Attia, P. Margetts and G. Guyatt, “Diagnosis of Thyroid Disease in Hospitalized Inpatients,” Archives of Internal Medicine, Vol. 159, No. 7, 1999, pp. 658-665. doi:10.1001/archinte.159.7.658
[7] G. G. Klee and I. D. Hay, “Biochemical Testing of Thyroid Function,” Endocrinology and Metabolism Clinics of North America, Vol. 26, No. 4, 1997, pp. 763-775. doi:10.1016/S0889-8529(05)70281-4
[8] Z. Hekimsky and I. Kavaladi Oktem, “Serum Creatine Kinase Levels in Overt and Subclinical Hypothyroidism,” Endocrine Research, Vol. 31, No. 3, 2005, pp. 171-175. doi:10.1080/07435800500371706
[9] I. W. Beyer, R. Karmali, N. Demeester-Mirikine, E. Cogan and M. J. Fuss, “Serum Creatine Kinase Levels in Overt and Subclinical Hypothyroidism,” Thyroid, Vol. 8, No. 11, 1998, pp. 1029-1031. doi:10.1089/thy.1998.8.1029
[10] P. Ladenson, P. A. Singer, K. B. Ain, N. Bagchi, S. T. Bigos, E. G. Levy, S. A. Smith, G. H. Daniels and H. D. Cohen, “American Thyroid Association Guidelines for Detection of Thyroid Dysfunction,” Archives of Internal Medicine, Vol. 160, No. 11, 2000, pp. 1573-1575. doi:10.1001/archinte.160.11.1573
[11] J. V. Parle, J. A. Franklyn, K. W. Cross, S. R. Jones and M. C. Sheppard, “Thyroxine Prescription in the Community: Serum Thyroid Stimulating Hormone Level Assays as an Indicator of Undertreatment or Overtreatment,” British Journal of General Practice, Vol. 43, No. 368, 1993, pp. 107-109.
[12] B. Vaidya and S. H. S. Pearce, “Management of Hypothyroidism in Adults,” British Medical Journal, Vol. 337, 2008, p. a801. doi:10.1136/bmj.a801
[13] C. T. Sawin, A. Gellar, J. M. Hershman, W. Castelli, P. Bacharach, “The Aging Thyroid. The Use of Thyroid Hormone in Older Persons,” JAMA, Vol. 261, No. 18, 1989, pp. 2653-2655. doi:10.1001/jama.1989.03420180077034
[14] M. C. Sheppard and D. B. Ramsden, “Abnormalities of Thyroid Function Tests in Hospital Inpatients,” Postgraduate Medical Journal, Vol. 61, No. 721, 1985, pp. 983-987. doi:10.1136/pgmj.61.721.983

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.