Hypothyroidism is a chronic disease that may result in significant long-term sequelae. Hypercholesterolemia is associated with hypothyroidism, increasing the long-term risk of cardiovascular disease and cardiovascular mortality.14 Between 4% and 14% of patients with hypercholesterolemia are found to be hypothyroid. The Colorado Thyroid Health Study showed a direct correlation between the degree of TSH elevation and the rise in serum cholesterol. Hypothyroidism also may result in increased systemic vascular resistance, decreased cardiac output, and increased diastolic blood pressure. Hypothyroidism can cause significant neuropsychiatric problems, including a dementia-like state in the elderly that is reversible with LT4 therapy. Maternal hypothyroidism can have dire consequences for the developing fetus. The fetus is almost completely dependent on maternal thyroid hormones during the first trimester, a time crucial for development of the CNS. Inadequately treated maternal hypothyroidism results in increased risk of miscarriage and developmental impairment in the child.15
Myxedema coma is seen in advanced hypothyroidism. These patients develop CNS depression, respiratory depression, cardiovascular instability, and fluid and electrolyte disturbances. Myxedema coma often is triggered by an underlying acute medical condition such as infection, stroke, trauma, or administration of CNS depressant drugs.
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