If you are experiencing a medical emergency, contact emergency services immediately: Emergency contacts and medical assistance
Hypothyroidism is usually a stable, well-managed condition. Crises are rare. But two scenarios warrant urgent action.
Scenario 1 — Myxoedema Coma
Myxoedema coma is the most severe manifestation of hypothyroidism — a life-threatening emergency caused by extreme, prolonged thyroid hormone deficiency. It is rare but has a high mortality rate (20–60%) even with treatment.
Who is at risk: Elderly patients with undiagnosed or inadequately treated hypothyroidism, often triggered by a precipitating event: infection, cold exposure, sedating medications, surgery, or trauma.
Warning signs: - Severe confusion or coma (reduced consciousness) - Profound hypothermia (very low body temperature — below 35°C) - Bradycardia (very slow pulse, < 50 bpm) - Slow, shallow breathing - Grossly swollen face and extremities (oedema) - Absent or minimal deep tendon reflexes
What to do: Emergency room immediately. Keep the patient warm. Myxoedema coma is treated with IV levothyroxine (or liothyronine) plus IV hydrocortisone (adrenal insufficiency must be excluded first), ICU monitoring, and management of the precipitating cause.
This is a PMB emergency. Your scheme must cover emergency and ICU treatment.
Scenario 2 — Running Out of Medication
This is the more common "crisis": your levothyroxine prescription has lapsed or you've run out and can't access a repeat quickly. While not immediately dangerous, abrupt cessation of levothyroxine after long-term use will cause progressive worsening over weeks.
What to do: 1. Contact your GP for an emergency prescription or telephonic consultation. 2. Most pharmacies can dispense a short emergency supply (typically 7 days) of an existing chronic medication on presentation of the original prescription or proof of CDL registration. 3. Your scheme's CDL medication is available at any designated service provider (DSP) pharmacy — ensure you know your scheme's DSP network.
Do not simply stop your levothyroxine. If you cannot access a prescription within a few days, contact your scheme's managed care line for assistance.
Scenario 3 — Symptoms Not Improving on Treatment (Not a Crisis But Urgent)
If you have been on levothyroxine for 3–6 months and symptoms are not improving — particularly fatigue, weight, and cognitive symptoms — this requires urgent assessment, not an emergency room.
Common causes of non-response: - Dose is still not optimal — TSH may still be out of range. Repeat TSH. - Absorption problem — Are you taking it on an empty stomach? Calcium, iron, or PPI medications significantly impair absorption. - Comorbidity — Depression, sleep apnoea, or anaemia may be causing persistent symptoms independent of thyroid status. - T4→T3 conversion issue — Some patients have poor conversion; specialist endocrinology review for T3 supplementation consideration.
Book an urgent GP appointment with a recent TSH result in hand.
Medical Aid Coverage in a Hypothyroidism Emergency
| Item | Covered? |
|---|---|
| ER assessment | YES — PMB emergency (myxoedema coma) |
| ICU admission for myxoedema coma | YES — PMB emergency |
| IV levothyroxine | YES — PMB emergency |
| Endocrinologist in hospital | YES — scheme specialist rate |
| Endocrinologist shortfall | Gap cover pays |
| Post-discharge oral levothyroxine | YES — CDL chronic medication |
Pre-Authorisation in an Emergency
- For myxoedema coma: your scheme must cover the emergency — it is a PMB emergency.
- Call your scheme's 24-hour line (on the back of your card) within 48 hours of any emergency admission.
- Notify your gap insurer with the admission date and treating doctors' details.
After the Crisis
- Review why the crisis occurred — was it untreated hypothyroidism, medication non-compliance, or a missed diagnosis? Adjust ongoing management accordingly.
- Ensure CDL registration is current and correctly reflecting your diagnosis. If your hypothyroidism is autoimmune (Hashimoto's), confirm this is captured in your CDL registration for accurate long-term management.
- Set up an automatic repeat prescription arrangement with your pharmacy. Levothyroxine is taken every day for life — a dispensing service or 3-month supply is more reliable than monthly collection.
- Follow up with your endocrinologist or GP within 4–6 weeks after any hospitalisation or medication change. Recheck TSH.
- Review any medications that may have contributed to the crisis — sedatives, amiodarone, lithium, and certain cancer therapies can impair thyroid function or precipitate myxoedema.
Emergency Contacts
- Emergency (private ambulance): 10177 | 082 911 (Netcare) | 084 124 (ER24)
- Emergency (public): 112 (mobile, all networks)
- Your scheme's 24-hour line: On the back of your medical aid card
Check your hypothyroidism cover → AURA check
This page is general information about medical schemes. It is not medical advice: speak to a healthcare professional about your own treatment. Medical aid and gap cover advice is given by Eldon de Waal, a Supervised Representative of Approach Administration (FSP 23579).