fTitle: Treatment of Severe Hypothyroidism
题目：严重的甲状腺功能减退症的治疗
Author 作者: Michael Bond

We do not see patients with severe hypothyroidism often, but it is important that they be treated aggressively. Some treatment pearls are
虽然我们并不常遇到严重的甲状腺功能低下的病人，但重要的是，他们一定要得到积极的治疗。一些治疗要点包括：
Rule out aggravating cause (i.e.: infection [UTI, pneumonia], myocardial infarction)
找出加重的原因（如：感染（尿路感染，肺炎），心肌梗死）
Start IV levothyroxine dosing
IV给甲状腺素的剂量
Initial dose 400-500 mcg. This is a large dose but it only saturates the thyroid receptors and will not cause a rebound hyperthyroidism state.
初始剂量400-500微克。这是一个很大的剂量，但它只能中和甲状腺受体并不会造成甲亢。
Daily dose 100 mcg/day
每日剂量100微克/天
Consider starting Dexamethasone/hydrocortisone
•考虑使用地塞米松/氢化可的松
Patients may also have adrenal insufficiency from primary pituitary failure or may have secondary adrenal suppression due to the severe hypothyroidism.  If dexamethasone/hydrocortisone is not provided they may develop severe adrenal insufficiency once you jump start their metabolism.
患者还可能有由原发性脑垂体功能衰竭引起的肾上腺皮质功能不全，或由严重的甲状腺功能低下引起的继发性肾上腺皮质功能抑制。如果不提供地塞米松／氢化可的松，一旦他们的新陈代谢开始，很可能发展成严重的肾上腺皮质功能不全。