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

## TL;DR

A rare case of severe hypothyroidism with hypertension in a cirrhosis patient is presented, highlighting the challenges of diagnosis and treatment.

## Contribution

This paper presents a unique clinical case linking decompensated hypothyroidism and hypertension in a cirrhosis patient.

## Key findings

- A 79-year-old cirrhosis patient showed severe hypothyroidism with high blood pressure.
- Intravenous levothyroxine improved the patient's condition within 4 days.
- Hypertension may result from compensatory vasoconstriction in low cardiac output.

## Abstract

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.

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.

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.

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