Hypothyroidism: A driving force behind accidents?

Hypothyroidism is a condition caused due to decreased production of thyroid hormones. The clinical presentation of hypothyroidism depends on the severity of the thyroid hormone deficiency and the acuteness of its development, regardless of its cause. The diverse clinical manifestations of hypothyroidism occur due to- • Accumulation and deposition of mucoplysaccharides and glycosaminoglycans in the interstitial spaces of various tissues resulting in the clinical symptoms of macroglossia, hoarseness of voice, slurring of speech, edema and peripheral neuropathy. • A generalized deceleration of the metabolic processes leading to bradycardia, fatigue, somnolence, drowsiness, cold intolerance, slow movement, weight gain, delayed relaxation of deep tendon reflexes, and bradycardia. Driving regulations in several countries screen for disorders like epilepsy, color blindness, type 1 diabetes and have guidelines issued before granting licenses to such individuals that may cause harm to themselves and the public. However, there are no standard guidelines and recommendations to rule out and screen for hypothyroidism prior to issuing a driving license. As hypothyroidism can virtually affect all the organ systems, and is characterized by diminished cognitive, fine motor performance and slowed reaction time, activities like driving can be disastrous. Thus, from a public health perspective routine screening for hypothyroidism must be made mandatory prior to issuing driving licenses. Keeping in mind a possible potential public and personal health hazard regarding impaired hypothyroid drivers, We hereby present a case report of a heavy motor vehicle driver presenting with features of severe myxedema sufficient to impede the safe operation of motor vehicles and could have been catastrophic.