Myxedema coma Diagnosis and Treatment

Myxedema coma 

  • This is a state of hypothyroidism with altered con­sciousness or coma, sometimes seizures. There may be hypothermia.
  • It is common in the elderly, and precipitated by seda-‘ tives, antidepressants, pneumonia, CHF, MI, cere­brovascular accidents.
  • marked by neurological dysfunction, by respiratory depression, and by lowered body temperature, blood pressure, blood sugar, and serum sodium.
  • System(s) affected: Endocrine/Metabolic
  • These patients may be hypoxaemic, hypercapneic, hyponatremic, hypoglycemic.
Myxedema coma

Myxedema coma Diagnosis and Treatment

Myxedema coma Risk Factors
  • History of Graves disease
  • Increasing age
  • Personal or family history of autoimmune diseases, including type 1 DM, Addison disease
  • Previous head or neck irradiation
  • Previous postpartum thyroiditis
  • Treatment with lithium, immune modulators such as IFN-, or the iodine-containing antiarrhythmic amiodarone

Myxedema coma DIAGNOSIS —

  • The diagnosis of myxedema coma is initially based upon the history, physical examination, and exclusion of other causes of coma

Myxedema coma Initial Lab Tests

  • •Primary hypothyroidism
    • Serum free T4 decreased
    • TSH elevated
  • •Central hypothyroidism:
    • Impaired TSH response to TRH
    • Serum free T4 decreased
    • TSH low
  • •Severe hypothyroidism:
    • Hyponatremia
    • Elevated CPK, LDH, AST
    • Elevated cholesterol
    • Anemia
  • •Subclinical hypothyroidism:
    • TSH elevated
    • Serum free T4 normal

Myxedema coma Treatment

  • Levothyroxine-single IV bolus 500 mcg loading dose then 100 mcg/day. Levothyroxine may be given by nasogastric tube as crushed tablets.
  • Patient is kept warm.
  • Hydrocortisone IV 50 mg 6 hrly is given. Broad spectrum antibiotics for infection. Hypertonic saline and IV glucose.

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