myxedema coma; hypothyroid coma
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Etiology
- systemic illness superimposed on previously undiagnosed hypothyroidism
Epidemiology
- rare
Pathology
Clinical manifestations
- poorly responsive (lethargy), unreponsive, coma
- hypotension, shock
- bradycardia
- hypothermia
- non-pitting peripheral edema, thickened skin[3]
Laboratory
- serum TSH: very high
- serum thyroxine: very low; free thyroxine: very low
- serum glucose: hypoglycemia
- serum cortisol
- serum sodium: hyponatremia
Diagnostic procedures
Radiology
- chest X-ray: rule out pneumonia
Complications
- aspiration pneumonia associated with hypoventilation & reduced level of consciousness
- cardiac arrhythmias associated with high-dose thyroxine
- mortality 20-15%[1]
Management
- medical emergency
- administer IV hydrocortisone 100 mg every 8 hours[1]
- unless serum cortisol > 18 ug/dL[1]
- start prior to administration of thyroxine to treat possible comorbid adrenal insufficiency[1]
- administer IV hydrocortisone 100 mg every 8 hours[1]
- 50-100 ug thyroxine IV every 6 hours for 24 hours
- monitor EKG
- ventilatory support as needed
- vasopressors as needed
- treat hypothermia[1]
- warmed intravenous fluids[1]
- treat precipitating systemic illness
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.
- ↑ Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med. 2007 Jul-Aug;22(4):224-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17712058
- ↑ 3.0 3.1 3.2 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Hampton J. Thyroid gland disorder emergencies: thyroid storm and myxedema coma. AACN Adv Crit Care. 2013 Jul-Sep;24(3):325-32. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23880755
- ↑ Klubo-Gwiezdzinska J, Wartofsky L. Thyroid emergencies. Med Clin North Am. 2012 Mar;96(2):385-403. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22443982
- ↑ Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. J Epidemiol. 2017 Mar;27(3):117-122. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28142035 Free PMC Article
- ↑ Kim J Myxedema N Engl J Med 2015; 372:764. February 19, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25693016 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1403210