Decompensated Hypothyroidism in a Patient With Cirrhosis: A Rare Presentation of Severe Hypothyroidism With Hypertension.

BACKGROUND/OBJECTIVE: Decompensated hypothyroidism (DH) is a rare endocrine emergency with a high mortality rate, particularly challenging to distinguish from hepatic encephalopathy (HE) in patients with cirrhosis due to overlapping symptoms.

CASE REPORT

We present a case of a 79-year-old woman with advanced cirrhosis and a history of multiple HE-related admissions, who exhibited altered mental status, hypothermia, bradycardia, and unusually high blood pressure. Laboratory findings revealed a severely elevated thyroid-stimulating hormone level (335.10 µUI/mL; reference range, 0.40-4.50 µUI/mL) and low free thyroxine level (0.2 ng/dL; reference range, 0.8-1.8 ng/dL), confirming DH. Adrenal insufficiency was ruled out. Intravenous levothyroxine was administered with a dose adjustment over 4 days, leading to significant clinical improvement by hospital day 1 and recovery to baseline by day 4.

DISCUSSION

This case highlights the complexity of diagnosing and managing DH in the context of cirrhosis. Notably, the pronounced hypertension observed may reflect compensatory systemic vasoconstriction in response to a low cardiac output state.

CONCLUSION

The complexity and severity of concomitant DH and HE underscore the necessity of prompt recognition and tailored treatment to prevent further complications.