The EM Educator Series: Decompensated Hypothyroidism

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!


Case 1:

A 72-year-old female presents from home with generalized weakness. She is bradycardic and has a temperature of 95F. ECG reveals low voltage.

Case 2:

A 55-year-old female is brought in by EMS with hypotension, bradycardia, and hypoglycemia. They gave her 1 amp D50, but a repeat blood glucose is 50. Her VS include HR 45, BP 88/49, RR 12, O2 sat 87% on RA, T 95F.

Case 3:

A 58-year-old male is brought in by EMS for altered mental status and suspected alcohol intoxication. He is hypoglycemic, slow to respond, and hypothermic. His CT head is normal, and exam reveals no source of infection or other signs of injury.



  • What is the differential diagnosis for altered mental status and unstable vital signs?
  • What are the triggers of decompensated hypothyroidism?
  • What are clinical presentations of decompensated hypothyroidism?
  • What ED diagnostics are helpful with making the diagnosis?
  • What is the ED management, and where can you go wrong?
  • Bonus: why is my patient not responding to the first-line vasopressor?


From Dr. Katy Hanson at Hanson’s Anatomy

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