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Myxedema coma
- 2. Myxedema coma is a state of decompensated hypothyroidism. A person may have lab values identical to a "normal" hypothyroid state, but a stressful event precipitates the myxedema coma state.
- 6. Primary symptoms of myxedema coma are altered mental status low body temperature. Low blood sugar, low blooodpressure, hyponatremia , hypercapnia, hypoxia, slowed heart rate, and hypoventilation m
- 7. Myxedema coma was first reported by Ord in 1879 in London. It is a rare disorder, with only approximately 300 cases described in the literature typically elderly females have longstanding, undiagnosed hypothyroidism More than 90% of cases occur during winter months
- 8. A 65-year-old woman with no known past medical history is brought to the emergency department with altered mental status. On arrival, the patient but arousable. Patient detailes R.R =15 b/m pH-7.23 O2 = 92% paCO2-63.7 Na = 128 mEq/L paO2-71.2 –R.A
- 9. Examination generalized puffiness, periorbital edema, ptosis, macroglossia, and her extremities are dry and cool with nonpitting edema. INVESTIGATION
- 11. The differential diagnosis of myxoedema coma will includes other causes of a deterioration in mental state: Hypothermia. Septic shock. Psychiatric disorders Dementia (including Alzheimer's disease),Depression Changes in mental state secondary to other medical conditions and drugs,Hypoglycaemia (may co-exist) Encephalitis and meningitis, Hepatic encephalopathy, Cerebrovascular disease.
- 19. Admit to intensive care unit for continuous monitoring of cardiovascular and pulmonary status Supportive care ABC measures Treat hypothermia with passive rewarming Treat hyponatremia with normal saline and free- water restriction
- 20. Thyroid hormone treatment Levothyroxine (T4) Loading dose: 300 to 400 μg IV then 50 to 100 μg IV daily until oral medication can be given If suboptimal response consider concurrent liothyronine (T3): 5μg IV every 8 hr
- 21. Corticosteroid therapy First draw baseline cortisol level and start hydrocortisone 100mg IV, followed by 50 mg IV every 6 to 8 hr Follow-up steroid therapy: