Hemodynamic and respiratory failures are strongly associated with worse outcomes. SH is a rare life-threatening emergency with various clinical presentations.
Multivariable analyses retained age > 70 years Sequential Organ-Failure Assessment score cardiovascular component ≥ 2 and ventilation component ≥ 2 as being independently associated with in-ICU mortality. In-ICU and 6-month mortality rates were 26% and 39%, respectively. Clinical presentations included hypothermia (66%), hemodynamic failure (57%), and coma (52%). The most frequent SH triggers were levothyroxine discontinuation (28%), sepsis (15%), and amiodarone-related hypothyroidism (11%). Thyroiditis and thyroidectomy represented the main SH etiologies (29% and 19%, respectively), while hypothyroidism was unknown in 44 patients (54%) before ICU admission. ResultsĮighty-two patients were included in the study.
Inclusion criteria were the presence of biological hypothyroidism associated with at least one cardinal sign among alteration of consciousness, hypothermia and circulatory failure, and at least one SH-related organ failure. The local medical records of patients from each participating ICU were screened using the International Classification of Disease 10th revision. We conducted a retrospective, multicenter study over 18 years in 32 French ICUs. We aimed to describe the clinical manifestations, management, and in-ICU and 6-month survival rates of these patients. Only a few data are available on its management and outcomes of the most severe forms requiring ICU admission. Severe hypothyroidism (SH) is a rare but life-threatening endocrine emergency. Future studies are indicated to understand the quality of care and developmental outcomes for children with CH and barriers to guideline adherence in evaluating for transient CH.Critically ill severe hypothyroidism: a retrospective multicenter cohort study Nearly one-third of children with suspected CH discontinued L-T4 by 3 years and fewer Medicaid-enrolled than privately-insured children received timely follow-up TSH testing. Among those who discontinued, 29.1% of privately-insured children and 47.7% of Medicaid-enrolled children had no claims for TSH testing within the next 180 days (P=0.01). By 36 months, 35.7% discontinued L-T4, with no difference by insurance status (P=0.48). More privately-insured than Medicaid-enrolled children had imaging between the first filled prescription and 180 days after the last filled prescription (24.3% vs.
This is a retrospective analysis of claims data from the IBM® MarketScan® Databases for children born during 2010–2016 and continuously enrolled in a non-capitated employer-sponsored private health insurance plan or in Medicaid for ≥36 months from the date of the first filled L-T4 prescription.Ģ63 privately-insured and 241 Medicaid-enrolled children met the inclusion criteria. To measure the rates of thyroid gland imaging and L-T4 discontinuation and to assess whether discontinuation was monitored with TSH testing.
#Hypothyroidism up to date trial#
For some, transient hypothyroidism can be ruled out by thyroid gland imaging otherwise, it is confirmed when thyroid stimulating hormone (TSH) concentrations remain normal after a supervised trial off L-T4, typically after age 3 years. Newborn screening identifies infants with congenital hypothyroidism (CH) for whom levothyroxine (L-T4) prevents cognitive impairment but also can identify infants with transient hypothyroidism.
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