Myxedema Coma: Symptoms, Diagnosis, and Management
By-
Dr.
Ajaz
Qadir
M
y
x
e
d
e
m
a
c
o
m
a
i
s
a
s
t
a
t
e
o
f
d
e
c
o
m
p
e
n
s
a
t
e
d
h
y
p
o
t
h
y
r
o
i
d
i
s
m
.
A
person
may
have lab values
identical
to
a
"normal"
hypothyroid
state,
but
a
stressful
event
precipitates
the
myxedema
coma
state.
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
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
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
pa
C
O2-63
.
7
paO2-71.2
–R.A
O2
=
92%
Na
=
128
mEq/L
Examination
generalized puffiness,
periorbital
edema,
ptosis,
macroglossia,
and her
extremities
are dry and
cool
with
nonpitting
edema.
INVESTIGATION
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.
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
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
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:
Myxedema coma is a rare, life-threatening condition associated with decompensated hypothyroidism. It presents with altered mental status, low body temperature, and various metabolic abnormalities. This article explores the primary symptoms, differential diagnosis, and management of myxedema coma based on a case study of a 65-year-old woman presenting to the emergency department. Learn about the key features, diagnostic approach, and potential differential diagnoses to consider in such cases.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
By- Dr.Ajaz Qadir
coma is a state of Myxedema decompensatedhypothyroidism. A person may have lab values identical to a "normal" hypothyroid state, but a stressful event precipitates the myxedema comastate.
Primary symptoms of myxedema comaare altered mental status low body temperature. Low bloodsugar, low blooodpressure, hyponatremia , hypercapnia, hypoxia, slowed heart rate, and hypoventilation m
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
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 butarousable. Patientdetailes R.R =15b/m O2 = 92% Na = 128 mEq/L pH-7.23 paCO2-63.7 paO2-71.2 R.A
Examination generalized puffiness, periorbital edema,ptosis, macroglossia, and her extremities are dry and cool with nonpittingedema. INVESTIGATION
The differential diagnosis of myxoedema coma will includes other causes of a deterioration in mental state: Hypothermia. Septicshock. Psychiatricdisorders Dementia (including Alzheimer's disease),Depression Changes in mental state secondary to other medical conditions and drugs,Hypoglycaemia (mayco-exist) Encephalitis and meningitis, Hepatic encephalopathy , Cerebrovasculardisease.
Admit to intensive care unit for continuous monitoring of cardiovascular and pulmonarystatus Supportivecare ABCmeasures Treat hypothermia with passive rewarming Treat hyponatremia with normal saline and free- waterrestriction
Thyroid hormone treatment Levothyroxine(T4) Loading dose: 300 to 400 g IV then 50 to 100 g IVdaily until oral medication can begiven If suboptimal response consider concurrent liothyronine (T3): 5 g IV every 8hr
Corticosteroidtherapy First draw baseline cortisol level and start hydrocortisone 100mg IV , followed by 50 mg IV every 6 to 8hr Follow-up steroid therapy:
