Abstract
Myxedema coma is the most severe manifestation of hypothyroidism. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a clinical challenge. It is typically caused by a precipitating event in an untreated or partially treated patient. Nearly every organ system is impaired in myxedema coma with varying degrees of severity. Depressed mental status and hypothermia are nearly universal. Severe hemodynamic and respiratory compromise can occur. Airway complications are rare but can be life threatening. Once the diagnosis is suspected, treatment should be initiated without delay. Thyroid hormone treatment, combined with ventilatory and hemodynamic support in the intensive care unit setting has improved the high mortality. The lack of controlled trials makes the optimal and most effective choice of thyroid hormone preparation controversial. Most patients can be managed with thyroxine alone, given intravenously at a loading dose, followed by standard oral regimen once clinical improvement is noted and adequate gastrointestinal motility is confirmed.
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References
Wartofsky L. Myxedema coma. In: Braverman LE, Utiger RD, editors. Werner and Ingbar’s the thyroid: a fundamental and clinical text. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000. p. 843–7.
Dutta P, Bhansali A, Masoodi SR, Bhadada S, Sharma N, Rajput R. Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Crit Care. 2008;12(1):R1.
Dubbs SB, Spangler R. Hypothyroidism: causes, killers, and life-saving treatments. Emerg Med Clin North Am. 2014;32(2):303–17.
Klubo-Gwiezdzinska J, Wartofsky L. Thyroid emergencies. Med Clin North Am. 2012;96(2):385–403.
Hawatmeh A, Thawabi M, Abuarqoub A, Shamoon F. Amiodarone induced myxedema coma: two case reports and literature review. Heart Lung. 2018;47(4):429–31.
Holvey DN, Goodner CJ, Nicoloff JT, Dowling JT. Treatment of myxedema coma with intravenous thyroxine. Arch Intern Med. 1964;113:89–96.
Lee CH, Wira CR. Severe angioedema in myxedema coma: a difficult airway in a rare endocrine emergency. Am J Emerg Med. 2009;27(8):1021.
Batniji RK, Butehorn HF 3rd, Cevera JJ, Gavin JP, Seymour PE, Parnes SM. Supraglottic myxedema presenting as acute upper airway obstruction. Otolaryngol Head Neck Surg. 2006;134(2):348–50.
Devdhar M, Ousman Y, Burman K. Hypothyroidism. Endocrinol Metab Clin N Am. 2007;36:595–615.
Schenck JB, Rizvi AA, Lin T. Severe primary hypothyroidism manifesting with torsades de pointes. Am J Med Sci. 2006;331:154–6.
Fukunaga K. Refractory gastrointestinal bleeding treated with thyroid hormone replacement. J Clin Gastroenterol. 2001;33:145–7.
Jansen HJ, Doebé SR, Louwerse ES, van der Linden JC, Netten PM. Status epilepticus caused by a myxoedema coma. Neth J Med. 2006;64(6):202–5.
Dayan CM. Interpretation of thyroid function tests. Lancet. 2001;357:619–24.
Farwell AP. Thyroid gland disorders. In: Fink MP, Abraham E, editors. Textbook of critical care. 5th ed. Philadelphia, PA: Elsevier Saunders; 2005. p. 1512–3.
Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670–751.
Ekka M, Ali I, Aggarwal P, Jamshed N. Cardiac tamponade as initial presenting feature of primary hypothyroidism in the ED. Am J Emerg Med. 2014;32(6):683.
Yamamoto T, Fukuyama J, Fujiyoshi A. Factors associated with mortality of myxedema coma: report of eight cases and literature survey. Thyroid. 1999;9:1167–74.
Hylander B, Rosenqvist U. Treatment of myxoedema coma—factors associated with fatal outcome. Acta Endocrinol. 1985;108(1):65–71.
Vaidya B, Pearce S. Management of hypothyroidism in adults. BMJ. 2008;337:a801.
Mills L, Lim S. Identifying and treating thyroid storm and myxedema coma in the emergency department. Emerg Med Pract. 2009;11(8):1–26.
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Pinar, A.U. (2020). Management of Myxedema Coma. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_57
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DOI: https://doi.org/10.1007/978-3-030-26710-0_57
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