MON-376 - Empiric Glucocorticoid Therapy in Severe Hypothyroidism: No Mortality Benefit in a Retrospective Cohort Study

Empiric Glucocorticoid Therapy in Severe Hypothyroidism: No Mortality Benefit in a Retrospective Cohort Study
Eugene Feigin MD, MHA, Noa Sirkis MD, Hussein Zaitoon MD MHA
Tel Aviv Sourasky Medical Center and Gray School of Medicine, Tel Aviv University, Tel Aviv, Israel;

Introduction:
Risk of adrenal insufficiency is a major concern among hospitalized patients with newly diagnosed severe hypothyroidism, especially when initiating levothyroxine that may trigger a life-threatening adrenal crisis. While the Endocrine Society and American Thyroid Association recommend empiric glucocorticoids prior to thyroid replacement, robust clinical evidence for this practice is sparse. This study aims to fill the evidence gap regarding whether empiric steroids improve outcomes during levothyroxine initiation in hospitalized patients with severe hypothyroidism .

Methods: The research retrospectively compared outcomes between adult patients with severe hypothyroidisms (TSH> 75 mIU/mL) treated with empiric glucocorticoids and those who were not. Key outcomes measured include:
Mortality: 7-day and 30-day rates.
Clinical Stability: Shock and length of hospitalization.
Metabolic Impact: Hyperglycemia and electrolyte imbalances (sodium/potassium).

Results: A total of 404 patients were included in the cohort. Sixty-seven patients were treated with glucocorticoids and 336 were not. There was no significant difference in 7-day and 30 day mortality in the treated and untreated group [ 3 (4.5%) vs. 12 (3.6%), p=0.723, and 9 (13.4%) vs. 44 (13.1%), p=1, respectively]. Length of stay was significantly longer in the treated group 16.63±18.64 compared to 8.73±12.58, p< 0.001. Adverse events were more frequent in the treated group: hyperkalemia 24 (35.8%) vs 71 (21.1%) p=0.012, hypokalemia 33 (49.3%) vs 107 (31.8%) p=0.008, hypernatremia 24 (35.8%) vs 35 (10.4%) p=0.001, hyponatremia 41 (61.2%) vs 130 (38.7%) p< 0.001, shock 16 (23.9%) vs 14 (4.5%) p< 0.001.

Discussion: There is no clear consensus on glucocorticoid treatment in patients with severe hypothyroidism. However, we show that such treatment is not linked to change in mortality outcomes. But it is linked to changes in softer adverse effects such as hyponatremia, hypernatremia, hypokalemia, hyperkalemia, and longer hospitalizations. There were differences between the populations that might affect the choices leading to treatment with glucocorticoids such as more severe illnesses and comorbidities however the mortality rate remained unchanged.

Conclusions:
There was no mortality difference in severe hypothyroid patients between those empirically treated with glucocorticoids and those who weren’t.

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