Hypothyroidism: Mimicker of common complaints

Hypothyroidism is a common condition presenting with many common complaints. This can pose a challenge to emergency physicians in diagnosing the underlying etiology of such vague complaints. Fortunately, testing for thyroid disease is now quicker and more sensitive than in the past with the newer generation TSH assays. This may prove especially helpful in the diagnosis of critically ill patients who are suspected of being in myxedema coma, a serious condition that arises when the body is in a decompensated hypothyroid state from a precipitating event. Even with the speed of the serum TSH assay, early treatment of suspected myxedema coma with thyroid hormone replacement (before TSH results) is necessary to avoid higher patient mortality. To do this, the emergency physician must maintain a high degree of clinical suspicion for thyroid disease in the ED.