Hypothyroidism + mental status changes/coma + hypothermia + precipitating stressor
Majority of the patients > 60yo
Occurs in 0.1% of patients with hypothyroidism
Usually occurs after precipitating incident in patient with untreated hypothyroidism 
Mortality may be as high as 60%
Untreated mortality approaches 100% 
~50% of cases become evident after admission
Severe hypothyroidism may be first time presentation of hypothyroid
Usually occurs after precipitating incident in patient with untreated hypothyroidism 
Bradycardia and hypothermia
Burns
CHF
CVA
Cold exposure
GI bleed
Metabolic abnormalities (hypoxia, hypercapnia, hyponatremia, hypoglycemia)
Medications: Beta blockers, sedatives, opioids, phenothiazines, amiodarone
Especially medications with CNS depressant effect 
Medication non-adherence (thyroid meds)
MI
Sepsis
Trauma
PE
Especially medications with CNS depressant effect<unk>  << hypothyroidism < euthyroid > hyperthyroidism >> thyroid storm
Myxedema coma
Adrenal crisis
Spinal shock
CHF
Neurogenic shock
CVA
Heat stroke
Depression