Critically ill severe hypothyroidism: a retrospective multicenter cohort study.

Mar 13, 2023

Experts: Simon Bourcier,Maxime Coutrot,Alexis Ferré,Nicolas Van Grunderbeeck,Julien Charpentier,Sami Hraiech,Elie Azoulay,Saad Nseir,Nadia Aissaoui,Jonathan Messika,Pierre Fillatre,Romain Persichini,Serge Carreira,Alexandre Lautrette,Clément Delmas,Nicolas Terzi,Bruno Mégarbane,Jean-Baptiste Lascarrou,Keyvan Razazi,Xavier Repessé,Claire Pichereau,Damien Contou,Aurélien Frérou,François Barbier,Stephan Ehrmann,Etienne de Montmollin,Benjamin Sztrymf,Elise Morawiec,Naïke Bigé,Danielle Reuter,David Schnell,Olivier Ellrodt,Jean Dellamonica,Alain Combes,Matthieu Schmidt

Severe hypothyroidism (SH) is a rare but life-threatening endocrine emergency. Only a few data are available on its management and outcomes of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management, and in-ICU and 6-month survival rates of these patients.
We conducted a retrospective, multicenter study over 18 years in 32 French ICUs. The local medical records of patients from each participating ICU were screened using the International Classification of Disease 10th revision. 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.
Eighty-two patients were included in the study. Thyroiditis and thyroidectomy represented the main SH etiologies (29% and 19%, respectively), while hypothyroidism was unknown in 44 patients (54%) before ICU admission. The most frequent SH triggers were levothyroxine discontinuation (28%), sepsis (15%), and amiodarone-related hypothyroidism (11%). Clinical presentations included hypothermia (66%), hemodynamic failure (57%), and coma (52%). In-ICU and 6-month mortality rates were 26% and 39%, respectively. Multivariable analyses retained age > 70 years [odds ratio OR 6.01 (1.75-24.1)] Sequential Organ-Failure Assessment score cardiovascular component ≥ 2 [OR 11.1 (2.47-84.2)] and ventilation component ≥ 2 [OR 4.52 (1.27-18.6)] as being independently associated with in-ICU mortality.
SH is a rare life-threatening emergency with various clinical presentations. Hemodynamic and respiratory failures are strongly associated with worse outcomes. The very high mortality prompts early diagnosis and rapid levothyroxine administration with close cardiac and hemodynamic monitoring.

© 2023. The Author(s).

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ABOUT THE EXPERTS

Simon Bourcier,Maxime Coutrot,Alexis Ferré,Nicolas Van Grunderbeeck,Julien Charpentier,Sami Hraiech,Elie Azoulay,Saad Nseir,Nadia Aissaoui,Jonathan Messika,Pierre Fillatre,Romain Persichini,Serge Carreira,Alexandre Lautrette,Clément Delmas,Nicolas Terzi,Bruno Mégarbane,Jean-Baptiste Lascarrou,Keyvan Razazi,Xavier Repessé,Claire Pichereau,Damien Contou,Aurélien Frérou,François Barbier,Stephan Ehrmann,Etienne de Montmollin,Benjamin Sztrymf,Elise Morawiec,Naïke Bigé,Danielle Reuter,David Schnell,Olivier Ellrodt,Jean Dellamonica,Alain Combes,Matthieu Schmidt

Simon Bourcier

Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France.

Maxime Coutrot

Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France.

Alexis Ferré

Intensive Care Unit, Versailles Hospital, Le Chesnay, France.

Nicolas Van Grunderbeeck

Department of Critical Care Medicine, Schaffner Hospital, Lens, France.

Julien Charpentier

Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, APHP, Paris, France.

Sami Hraiech

Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France.

Elie Azoulay

Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France.

Saad Nseir

Médecine Intensive-Réanimation, CHU de Lille, 59000, Lille, France.

INSERM U1285, Université de Lille, CNRS, UMR 8576 – UGSF – Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France.

Nadia Aissaoui

Department of Critical Care Unit, Hôpital Européen Georges-Pompidou (HEGP), APHP, Paris, France.

Jonathan Messika

Medico-Surgical Intensive Care Unit, APHP. Nord-Université Paris Cité, Hôpital Louis Mourier, 92700, Colombes, France.

Pierre Fillatre

Medical-Surgical Intensive Care Unit, CH de Saint-Brieuc, Saint-Brieuc, France.

Romain Persichini

Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire (CHU) de La Réunion, Felix-Guyon Hospital, Saint-Denis, La Réunion, France.

Serge Carreira

Medical-Surgical Intensive Care Unit, Saint-Camille Hospital, Bry-sur-Marne, France.

Alexandre Lautrette

Medical Intensive Care Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France.

Clément Delmas

Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059, Toulouse, France.

REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France.

Nicolas Terzi

Department of Medical Intensive Care, CHU de Grenoble Alpes, Grenoble, France.

Bruno Mégarbane

Department of Medical Intensive Care, Lariboisière Hospital, APHP, Paris, France.

Jean-Baptiste Lascarrou

Médecine Intensive Réanimation, CHU de Nantes, Nantes, France.

Keyvan Razazi

Service de Médecine Intensive Réanimation, AP-HP, CHU Henri Mondor, DHU A-TVB, Créteil, France.

Xavier Repessé

Intensive Care Unit, University Hospital Ambroise-Paré, APHP, Boulogne-Billancourt, France.

Claire Pichereau

Intensive Care Unit, Poissy Saint-Germain-en-Laye Hospital, Poissy, France.

Damien Contou

Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.

Aurélien Frérou

Medical Intensive Care Unit, Hôpital Pontchaillou, CHU de Rennes, Rennes, France.

François Barbier

Medical Intensive Care Unit, CH Regional d’Orléans, Orléans, France.

Stephan Ehrmann

Médecine Intensive Réanimation, CHRU Tours, CIC INSERM 1415, CRICS-TriggerSep F-CRIN Research Network, Tours, France.

INSERM, Centre d’étude Des Pathologies Respiratoires, U1100, Tours, France.

Université de Tours, Tours, France.

Etienne de Montmollin

Medical-Surgical Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France.

Benjamin Sztrymf

Service de Réanimation Polyvalente et Surveillance Continue, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Triveaux, 92140, Clamart, France.

Elise Morawiec

Service de Pneumologie et Réanimation Médicale (Département “R3S”), Hôpital de la Pitié-Salpêtrière, APHP, Paris, France.

Naïke Bigé

Medical Intensive Care Unit, Hôpital Saint-Antoine, APHP, Paris, France.

Danielle Reuter

Medical-Surgical Intensive Care Unit, CH Sud Francilien, Corbeil, France.

David Schnell

Service de Réanimation Polyvalente, CH d’Angoulême, Angoulême, France.

Olivier Ellrodt

Département de Médecine Intensive, Groupe Hospitalier Sud Île-de-France, Hôpital de Melun, Melun, France.

Jean Dellamonica

Service de Médecine Intensive Réanimation, Hôpital Archet 1, Centre Hospitalier Universitaire de Nice, UR2CA Université Cote d’Azur, Nice, France.

Alain Combes

Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France.

Medecine Intensive Reanimation, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, INSERM, UMRS_1166-ICAN, Hôpital de la Pitié-Salpêtrière, 47, bd de l’Hôpital, 75651, Paris Cedex 13, France.

Matthieu Schmidt

Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France. matthieu.schmidt@aphp.fr.

Medecine Intensive Reanimation, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, INSERM, UMRS_1166-ICAN, Hôpital de la Pitié-Salpêtrière, 47, bd de l’Hôpital, 75651, Paris Cedex 13, France. matthieu.schmidt@aphp.fr.