TITLE:
Overt Hypothyroidism in Hospitalized Patients: Clinical Characteristics
AUTHORS:
Pnina Rotman-Pikielny, Oksana Borodin, Rivka Zissin, Yair Levy
KEYWORDS:
Hypothyroidism; Hospitalized Patients; Inpatients
JOURNAL NAME:
Open Journal of Endocrine and Metabolic Diseases,
Vol.3 No.2,
May
23,
2013
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.