Abstract
Three consecutive cases of myxedema coma treated successfully with either nasogastric or intravenous route of administration of l-triiodothyronine, followed by oral thyroxine, are described. All were hypothermic, had biochemical evidence of advanced hypothyroidism (T4 < 1.0 μg/dl, T3 < 20 ng/dl and TSH > 150μU/ml), severe hypoxemia, respiratory acidosis, hypercarbiaand temporary depression of respiratory center responsiveness. In only one patient it was found significant hyponatremia (Na = 127 mEq/l). Two patients were successfully treated with the nasogastric route of administration of T3 (12.5μg/6h) but in a female patient with intestinal atony (ileus) there was no absorption of the orally administered T3. Intravenously administered T3 promptly corrected the hypometabolic state in this patient. It was confirmed that T4 therapy, although promptly correcting low serum T4 concentration, failed to rise serum T3levels due to lack of peripheral T4 5’-monodeiodination to T3 in these critically ill patients.
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References
Forester C.E. Coma in myxedema. Arch. Intern. Med. 111: 734, 1963.
Leon-Sottomayor L., Bowers C.Y. Myxedema coma. Charles C. Thomas, Springfield, 1964.
Blum M. Myxedema coma. Am. J. Med. Sci. 264: 432, 1972.
Domn B.M., Vassalo C.L. Myxedema coma with respiratory failure. Am. Rev. Respir. Dis. 107: 842, 1973.
Holvey D.N., Goodner C.J., Nicoloff J.T., Dowling J.T. Treatment of myxedema coma with intravenous thyroxine Arch. Intern. Med. 113: 139, 1964.
Kelly J.J., Sherk H.H. Myxedema coma. Ann. Intern. Med. 50: 1303, 1959.
Khaleeli A.A. Myxedema coma: a report on five successfully treated cases. Postgrad. Med. J. 54: 825, 1978.
Krowshky W.R., Kikuchi T.A. The role of vasopression in the impaired water excretion of myxedema. Am. J. Med. 64: 613, 1978.
Lizarralde G., Baldwin J.G., McCulley Jr. H.G., Packer III R.M. Myxedema coma and normal serum thyroxine. South. Med. J. 71: 860, 1978.
Newmak S.R., Himathongkam T., Shane J.M. Myxedema coma. JAMA 230: 884, 1974.
Nordqvist P., Dhuner K.G., Stenberg K., Orndahl G. Myxedema coma and C02 retention. Acta Med. Scand. 766: 189, 1960.
Pettinger W.A., Talner L., Ferris T.F. Inappropriate secretion of antidiuretic hormone due to myxedema. N. Engl. J. Med. 272: 362, 1965.
Royce P.C. Severely impaired consciousness in myxedema. Am. J. Med. Sci. 267: 46, 1971.
Senior R.M., Birge S.J. The recognition and management of myxedema coma. JAMA 217: 61, 1971.
Braverman L.B. Treatment of hypothyroidism, a pratical guide. Thyroid Today 2: 1, 1979.
Ingbar S.H., Woeber K.A. Myxedema coma. In: Williams R.H. (Ed.), Textbook of endocrinology, ed. 6. WB Saunders Co, Philadelphia, 1981, p. 225.
Medeiros-Neto G.A. Coma mixedematoso. In: M.M. Rabelo (Ed.), Endocrine emergencies. Bigraf (BAHIA), Salvador, 1976, p. 51.
Curtis H.R. Hyponatremia in primary myxedema. Ann. Intern. Med. 44: 376, 1956.
Massumi R.A., Winnacker J.L. Severe depression of the respiratory center in myxedema. Am. J. Med. 36: 876, 1964.
Burger A., Nicod P., Suter P., Vallotton M.B., Vagenakis A., Braverman L. Reduced active thyroid hormone levels in acute illness. Lancet 1: 653, 1976.
Larsen P.R., Silva J.E., Kaplan M.M. Relationship between circulating and intracellularthyroid hormones: physiological and clinical implications. Endocr. Rev. 2: 87, 1981.
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Pereira, V.G., Haron, E.S., Lima-Neto, N. et al. Management of myxedema coma: report on three successfully treated cases with nasogastric or intravenous administration of triiodothyronine. J Endocrinol Invest 5, 331–334 (1982). https://doi.org/10.1007/BF03350523
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DOI: https://doi.org/10.1007/BF03350523