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Utility of myxedema score as a predictor of mortality in myxedema coma

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Abstract

Objective

Myxedema crisis (MC) is a rare condition. There is a dearth of data regarding the predictors of mortality in MC. Predictive scores for mortality specific to the clinical and biochemical profile of MC are still lacking.

Design and methods

All consecutive patients presenting with MC from September 2006 to December 2020 comprised the new cohort. Patients managed between January 1999 and August 2006 comprised the old cohort. Both cohorts were compared for the determination of secular trends. Combined analysis of both the cohorts was done for clinico-demographic profile and predictors of mortality. Myxedema score (MS) and qSOFA (Quick Sequential Organ Failure Assessment) score were evaluated in all the patients.

Results

A total of forty-one patients (new cohort; n = 18 and old cohort; n = 23) were enrolled into the study. There was a female predominance (80.5%). Nearly half (51.2%) of the patients were newly diagnosed with hypothyroidism on admission. Overall mortality was 60.9%. On comparative analysis among survivors and non-survivors, female gender (OR 20.4, p value 0.018), need for mechanical ventilation (OR16.4, p value 0.009), in-hospital hypotension (OR 9.1, p value 0.020), and high qSOFA score (OR 7.1, p value 0.023) predicted mortality. MS of > 90 had significantly higher mortality (OR-11.8, p value - 0.026) while MS of > 110 had 100% mortality. There was no change in secular trends over last 20 years. There was no difference in outcome of patients receiving oral or IV levothyroxine.

Conclusion

Myxedema crisis is associated with high mortality despite improvement in health care services. The current study is first to elucidate the role of the MS in predicting mortality in patients with MC.

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Acknowledgements

We wish to acknowledge Prof. Nihal Thomas, Department of Endocrinology, CMC Vellore and the Department of Pharmacy, CMC Vellore for sharing the protocol of preparation of intravenous levothyroxine therapy, used in one of the patients.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension Block, 1012, Chandigarh, 160012, India

    S Chaudhary, L Das, N Sachdeva, A Bhansali & P Dutta

  2. Department of Internal Medicine, PGIMER, Chandigarh, India

    N Sharma

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  1. S Chaudhary
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  2. L Das
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  3. N Sharma
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  4. N Sachdeva
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  5. A Bhansali
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  6. P Dutta
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Contributions

All authors have met all the following criteria: i) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; ii) drafting the article or revising it critically for important intellectual content; iii) approval of the version to be published and all subsequent versions.

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Correspondence to P Dutta.

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All procedures in studies performed in human participants were in accordance with the ethical standards of the institutional and/or national ethics research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written, informed consent was obtained from the relatives of the patients included in the study.

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Chaudhary, S., Das, L., Sharma, N. et al. Utility of myxedema score as a predictor of mortality in myxedema coma. J Endocrinol Invest 46, 59–65 (2023). https://doi.org/10.1007/s40618-022-01884-6

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  • DOI: https://doi.org/10.1007/s40618-022-01884-6

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