It occurs most often in elderly women and may be mistaken for one of the chronic debilitating diseases common to this age group. Treatment of myxedema coma with intravenous thyroxine. Welcome to journal of the association of physicians of india. The magnitude of hypothyroidism dictates dose and route. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread. It is a medical emergency with a high mortality rate.
Myxedema coma is a rare, lifethreatening condition, occurs late in the progression of hypothyroidism. Most people tend to ignore the condition, ruling out its severity, but if the condition remains untreated for long time it might become deadly. Symptoms can manifest in all organ systems and range in severity based on the degree of hormone deficiency. Not considering underlying triggers of myxedema coma. Myxedema coma is a true endocrine emergency and should be treated aggressively in an intensive care setting. Myxedematous coma is a syndrome that results from the intense reduction of the thyroid hormone synthesis. Decompansated hypothyroidsm myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood hypothyroidism.
If the patient has recently moved for example into residential care, their. Mild myxedema coma usually is treated by a general practitioner or internist while moderate to severe myxedema coma is treated and managed by an endocrinologist. Myxedema, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult. Has there been any other recent change in the patients circumstances.
Treatment should be initiated on the basis of clinical suspicion without waiting for laboratory results. It should be treated in an intensive care unit icu with close monitoring of the blood glucose and other electrolytes salts and treatment to slowly decrease the blood glucose. Findings neck thyroidectomy scar goiter uncommon dermatologic dry, scaly, yellow skin loss of lateral 3rd of eyebrows nonpitting waxy edema of face extremities 41. Myxedema coma is a severe form of hypothyroidism low thyroid function. T3 may be a better agent than t4 in the critically ill hypothyroid patient. Elderly people are at a higher risk of having a poor outcome. Myxedema also refers to the swelling of the skin and soft tissue that occurs in patients who are hypothyroid.
Current medical diagnosis and treatment 2015 54 e 2014. Traumatic brain injuries are the most frequent cause. Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. Primary hypothyroidism stems from dysfunction of the thyroid gland. Apr 16, 2014 myxoedema coma can be regarded as a form of decompensated hypothyroidism in which the adaptations of the body to untreated hypothyroidism fail to maintain homoeostasis and become overwhelmed by hypothermia, infection or other precipitating factors. The mortality rates may be as high as 25 to 60 percent even with treatment. Myxedema coma is a severe form of hypothyroidism in which alterations in cerebral bloodflow andglucosemetabolism maylead tosignificant changesinmental status27 and coma. Guidelines for the diagnosis, treatment and prevention of leprosy.
While oral levothyroxine is recommended in these patients, the enteral route can be used if oral therapy is not feasible. Patients are often placed in the intensive care unit for continuous monitoring and treatment. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. Myxedema coma definition, symptoms, causes, treatment. In this latter sense, myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. Diagnosis diagnosis is clinical thyroid panel reflects chronic state 43. This is the most common type of hypothyroidism and is caused by disease autoimmune thyroiditis hashimotos disease or loss of the thyroid gland iodine deficiency, radioactive iodine treatment, surgical removal of the gland. Myxedema coma was diagnosed, and lthyroxine sodium 500. Without a rapid diagnosis, myxedema crisis is often fatal.
Myxedema crisis can be treated and managed if it is diagnosed early. The diagnosis of myxedema coma may easily be made in a patient who presents with the previously described general appearance and physical findings and with a history of previous thyroid hormone medication, radioactive iodine therapy, or subtotal thyroidectomy. Myxedema is a term used synonymously with severe hypothyroidism. Myxedema coma, occasionally called myxedema crisis, is a rare lifethreatening clinical condition that represents severe hypothyroidism with physiological decompensation. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis due to the high associated mortality rate. Myxedema and coma severe hypothyroidism endotext ncbi. Myxedema coma definition of myxedema coma by medical dictionary. This is a clinical diagnosis and mortality rises with delays in management.
Drugs used to treat myxedema coma the following list of medications are in some way related to, or used in the treatment of this condition. Diagnosing and treating myxedema and myxedema coma. Albuquerque, new mexico nm dual diagnosis treatment centers. Assuming hypothermia is from environmental exposure myxedema coma most commonly occurs in the winter. The term myxedema is often used interchangeably with hypothyroidism and myxedema coma.
Myxedema coma treatment, symptoms, causes, diagnosis. Treatment should be instituted in patients with presumed myxedema coma without waiting for laboratory confirmation. Thyroid hormones help control body temperature, heart rate, growth, and weight. Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling. The code is valid for the year 2020 for the submission of hipaacovered transactions. It can be brought about by removal of the thyroid for any cause, by a cessation of function of the gland, or simply by glandular atrophy.
Risk factors for death in patients with myxedema coma. What is grave condition compared to critical condition. Treatment begins with intravenous levothyroxine and intravenous hydrocortisone until associated adrenal insuf. We have been helping people who are seeking treatment for addiction connect with local rehab facilities in their local area who fit their needs since 2006. Most cases are well controlled with lifelong medication. If not recognised, however, in time it may develop into the most severe manifestation of hypothyroidism known as myxedema coma. Coma critical condition doctors answer your questions. However, the term is also used to describe a dermatological change that can occur in hyperthyroidism and rare paradoxical cases of hypothyroidism. The sooner a person is treated, the more likely they are to recover. Myxedema coma is an endocrinologic emergency and is the most clinically severe form of hypothyroidism. Using the key words myxedema with the word aged, medline files were searched from 1989. It is important to suspect myxedema coma in patients with a history of hypothyroidism presenting with altered mental status after a known precipitating event and to begin empiric treatment with large doses of synthetic t4 200400 mcg and t3 promptly to avoid complications. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory.
It is a medical emergency and associated with increased risk of death. Coma must be differentiated from other pathologic changes in consciousness such as brain death, vegetative state, and delirium, although it may be difficult to do. Myxedema coma in the elderly journal of the american board of. Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Use of this website is conditional upon your acceptance of our user agreement. The nonspecific presenting feature of myxedema coma is a complicating factor in making the correct diagnosis, and without the diagnosis, treatment cannot be optimized. However, these patients tend to bleed and pericardial effusions will improve over time following treatment with thyroid hormone. Details about how the affected person lost consciousness, including whether it occurred suddenly or over time. Mild cases may be treated with gradual oral replacement, but patients with myxedema coma usually require large doses of iv replacement. A precipitating factor may be evident in less than 50% of cases 7. Current diagnosis and treatment cardiology, fifth edition. Subscribe to endo monitor, the endocrineweb enewsletter for hcps. A coma is a state of prolonged unconsciousness that can be caused by a variety of problems traumatic head injury, stroke, brain tumor, drug or alcohol. These adaptations include peripheral vasoconstriction to maintain core body temperature.
An individual in a coma is alive but unable to move or respond to his or her environment. Primary treatment is prompt administration of adequate doses of thyroid hormoneeither lthroxine given intravenously of ltriiodothyronine given by nasogastric tube. Myxedema definition, symptoms, what is, treatment, pictures. Hypothyroidism is a frequently diagnosed and simply treated disease. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only.
Intensive care treatment with airway and ventilation support. Evaluation of a patient in a coma is comprehensive. Myxedema coma is a rare medical condition that is the extreme manifestation of severe hypothyroidism. Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. Though not common, this advanced stage is more life threatening than the earlier stages. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than frankly comatose. If a doctor suspects myxedema coma, they will recommend that treatment begins immediately. It is crucial to diagnose this condition properly as any misdiagnosis can give rise to serious health risks.
The mortality rates may be as high as 2560% even with best possible treatment 15. Mar 24, 2020 hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. Coma israel pdf ppt case reports symptoms treatment. Intubation and mechanical ventilation may be required due to coma. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. Jul 06, 2017 without a rapid diagnosis, myxedema crisis is often fatal. Dec 26, 2018 myxedema crisis or coma, is a rare and potentially fatal condition caused by low levels of thyroid hormones produced by the thyroid gland. Myxoedema coma is a rare, reversible condition with a high mortality and should be considered as a differential diagnosis in medical emergencies. Pdf diagnosis of myxedema coma complicated by renal failure. The condition is seen typically in elderly women and is often precipitated by infection, medication, environmental exposure, or other metabolicrelated stresses.
Myxedema coma occurs when thyroid hormone levels are not treated or controlled. Patients with myxedema coma should be managed in an intensive care unit with continuous cardiac monitoring. Doctor answers on symptoms, diagnosis, treatment, and more. A swift diagnosis can be critical to a patients prognosis. Early recognition and therapy of myxedema coma are essential. Myxedema coma is a condition where longterm hypothyroidism is not treated or is poorly controlled. The diagnosis of myxedema coma is made when the three key diagnostic features of myxedema coma are present, which include altered mental status, hypothermia or absence of fever and a precipitating event such as cold exposure, infection, drugs. Current medical diagnosis and treatment 2017 56th edition pdf. During a coma, a person does not react to external stimuli and they will not show normal reflex responses. Lack of enough thyroid hormone for a prolonged duration can make patients slip into a coma.
Myxedema information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. Myxedema coma can be triggered by not taking medicine to treat hypothyroidism. Long periods of low thyroid hormones may lead to a fatal condition known as myxedema coma. This will depend on the local language used by your dr team so discuss with them. There are some triggering factors like exposition to low temperatures, infections, irregular performance of hormone replacement therapy in patients with hypothyroidism, adverse reactions of medications like amiodarone, lithium, anesthetics, hypnotics, sedatives or tranquilizers.
The aim of this study was to identify the factors that may increase the risk of death for the patients hospitalized for myxedema coma. Diagnosis usually involves physical observation and consideration of the symptoms experienced by patients. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory failure from. Myxedema symptoms, diagnosis, treatments and causes. Hypothyroidism and myxedema coma differential diagnoses.
Myxedema coma is a medical emergency that requires immediate attention. Important clues to the possible presence of myxedema coma in a poorly responsive patient are the presence of a thyroidectomy scar or a history of radioiodine therapy or hypothyroidism. Evaluation of transport across the bloodbrain barrier in a primate model. Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death. We developed an objective screening tool for myxedema coma to more easily identify patients and examine the best treatment method in future prospective studies to reduce the mortality of this entity. An atypical case of myxedema coma with concomitant. Coma may occur as a complication of an underlying illness, or as a result of injuries, such as brain injury. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. The goal of treatment should be longterm normalization of serum thyroidstimulating hormone tsh when steady state thyroid hormone levels are achieved. Chernow b, burman kd, johnson dl, mcguire ra, obrian jt, wartofsky l, georges lp. Myxedema can be associated with coma in rare cases.
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