From the Guidelines
You should go to the hospital for uncontrolled hypothyroidism if you experience severe symptoms such as myxedema, which includes bradycardia, hypothermia, and altered mental status, as these are life-threatening consequences that require immediate medical attention. According to the guidelines for managing immune-related adverse events in patients treated with immune checkpoint inhibitor therapy, hospital admission is recommended for developing myxedema 1. This condition is a medical emergency that necessitates a high level of care, including inpatient endocrinology consultation to assist with IV levothyroxine dosing, steroids, and supportive care.
Some key symptoms that indicate the need for hospitalization include:
- Severe symptoms, medically significant or life-threatening consequences
- Unable to perform activities of daily living (ADL)
- Myxedema coma, which is a life-threatening emergency requiring admission
- Bradycardia, hypothermia, and altered mental status
It's essential to note that while most hypothyroidism cases are managed through outpatient care with medications, severe untreated cases can lead to dangerous complications affecting multiple body systems 1. The guidelines suggest that for patients with severe symptoms (G3-4), ICPi should be held until symptoms resolve to baseline with appropriate supplementation, and endocrine consultation should be sought to assist with rapid hormone replacement 1.
In terms of management, the guidelines provide a grading system for hypothyroidism, with recommendations for monitoring and treatment based on the severity of symptoms and TSH levels 1. For example, for patients with moderate symptoms (G2), ICPi may be continued or held until symptoms resolve to baseline, and thyroid hormone supplementation should be prescribed in symptomatic patients with any degree of TSH elevation or in asymptomatic patients with TSH levels that persist over 10 mIU/L 1.
From the Research
Symptoms of Uncontrolled Hypothyroidism
- Fatigue
- Weight gain
- Dry skin
- Constipation
- Cold intolerance
- Voice changes
- Hyponatremia
When to Go to the Hospital
- If symptoms are severe or life-threatening, such as myxedema coma, which is characterized by altered mental status, hypothermia, hypotension, hyponatremia, and hypoventilation 2, 3, 4
- If there are signs of myxedema coma, such as deterioration of mental status, hypothermia, hypotension, hyponatremia, and hypoventilation 3, 4
- If the patient has a history of hypothyroidism and is experiencing severe symptoms, such as fatigue, weight gain, constipation, and cold intolerance 5, 6
- If the patient has a high-risk condition, such as heart disease, pregnancy, or myxedema coma, and is experiencing symptoms of uncontrolled hypothyroidism 5, 6
Importance of Early Recognition and Treatment
- Early recognition of myxedema coma and appropriate treatment is essential to prevent mortality 5, 2
- Treatment with thyroid hormone replacement should be initiated upon suspicion of myxedema coma, even prior to obtaining laboratory confirmation 4
- Stress doses of hydrocortisone should also be given until coexisting adrenal insufficiency is excluded 2, 4