Management

General supportive measures:

• IV fluids - but be careful not to precipitate left ventricular failure
• oxygen if cyanosed
• antibiotics if infection suspected
• treat hypothermia
• treat heart failure

Replacement of thyroid hormone:

• traditionally, T3 - 100 microg i.v. bolus followed by 20 micro g tds until condition improves; then substitute T4 50 micro g per 24 hours p.o.; T3 acts most quickly but may worsen ischaemic heart disease; alternatively, 400-500 micro g T4 i.v.
• glucocorticoid replacement - usually, hydrocortisone, 100mg tds i.v. - in conjunction with T3 in suspected secondary hypothyroidism