a very high TSH

Friday morning we chatted about an elderly patient who presented with hallucinations and was found to have a very high TSH (98).

In hypo and hyperthyroidism it is important to consider that elderly patients may have atypical or apathetic presentations so TSH should be ordered because thyroid disorders are systemic and often have very non specific symptoms

For a good article on thyroid related emergencies see my previous post.

Here is an odd cause of severe hypothyroidism and myxedema coma

Here is a prospective study on the starting dose for treating hypothyroidism. These results — plus common sense — suggest that slow titration probably is unnecessary for young healthy patients but is prudent for older patients or those at risk for coronary ischemia.