title: Diagnosis of unrecognized primary overt hypothyroidism in the ED.
abstract: OBJECTIVE
  The aims of the study were to evaluate the incidence of newly diagnosed primary overt hypothyroidism among adults admitted through the emergency department (ED) and to assess how previously undiagnosed hypothyroidism presents.
  
  
  METHODS
  From July 1, 2002 to June 30, 2006, 56 adult patients were enrolled for further analysis.
  
  
  RESULTS
  The incidence of newly diagnosed primary overt hypothyroidism among adults admitted through the ED is 0.1%. The mean age of the patients was 75.8 ± 12.8 years (range, 27-98 years). Most of our patients presented in the winter. Individual symptoms and signs were not sensitive. Drugs (13 patients, 23%), nongoitrogenous autoimmune thyroiditis (12 patients, 21%), and previous surgery or irradiation related (11 patients, 20%) are frequent causes of unrecognized hypothyroidism in this iodine-replete region. Only 21% of patients were admitted with a correct initial impression. Half of myxedema coma patients were missed during the initial ED stay. Thirty-three patients (59%) had cardiomegaly on chest x-ray receiving further echocardiography examination. Pericardial effusion was found in 18 patients. Of these, 7 patients had moderate to large pericardial effusion, but none had cardiac tamponade. Only 6 patients have depressed left ventricular ejection fraction (<40%).
  
  
  CONCLUSIONS
  The diagnosis of hypothyroidism is often missed during the ED evaluation of patients at risk for this uncommon disease. Hypothyroidism should always be considered in patients who present with nonspecific symptoms suggestive of the disease, including weakness, cold intolerance, and alterations in mental status, and receive drugs impairing thyroid function or treatment of advanced head and neck cancer. In addition, patients with stable chronic heart failure or unexplained pericardial effusion warrant serum thyroid testing.
authors.affiliation: Emergency Department, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors.forename: Ying-Ju
authors.initials: YJ
authors.lastname: Chen
authors.forename: Sen-Kuang
authors.initials: SK
authors.lastname: Hou
authors.forename: Chorng-Kuang
authors.initials: CK
authors.lastname: How
authors.forename: Chii-Hwa
authors.initials: CH
authors.lastname: Chern
authors.forename: Hong-Chang
authors.initials: HC
authors.lastname: Lo
authors.forename: David Hung-Tsang
authors.initials: DH
authors.lastname: Yen
authors.forename: Chun-I
authors.initials: CI
authors.lastname: Huang
authors.forename: Chen-Hsen
authors.initials: CH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006332:Cardiomegaly / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009230:Myxedema / Q000175:diagnosis; D010490:Pericardial Effusion / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013972:Thyrotropin / Q000097:blood
chemical_list: D013972:Thyrotropin