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Case Reports in Medicine 2019Hypothyroidism is common, with an extreme manifestation of myxedema coma if untreated. Hematologic consequences of myxedema coma include mild leukopenia and anemia,...
Hypothyroidism is common, with an extreme manifestation of myxedema coma if untreated. Hematologic consequences of myxedema coma include mild leukopenia and anemia, rarely pancytopenia. We present a patient with typical symptoms of myxedema coma, but found to be pancytopenic, with sustained response to levothyroxine and blood transfusion for anemia.
PubMed: 31396281
DOI: 10.1155/2019/2320751 -
Annals of Medicine and Surgery (2012) Oct 2022Hypothyroidism is a common condition in the general population that presents a wide array of medical, neurological and psychiatric symptoms. However, hypothyroidism...
INTRODUCTION
Hypothyroidism is a common condition in the general population that presents a wide array of medical, neurological and psychiatric symptoms. However, hypothyroidism rarely leads to acute psychosis, termed myxedema psychosis (MP) and is often missed by many physicians.
CASE PRESENTATION
Here we report a case of a 36-years-old female who presented with a one-week history of abnormal behavior, delusions and hallucinations. Investigations revealed a high thyroid-stimulating-hormone (TSH)of 78.60 mlU/mL and low free thyroxine (FT4) of 0.64 pmol/L. Diagnosed with hypothyroidism, she was treated with oral thyroid hormone replacement (l-thyroxine 75 μg/day) with antipsychotics and her symptoms settled within days. She was discharged off antipsychotics and advised to adhere to thyroxine replacement and to follow up for Thyroid function test (TFT).
DISCUSSION
Myxedema psychosis is an uncommon manifestation of the common endocrine disease hypothyroidism. The atypical nature of presentations occasionally complicates diagnostics. When approaching a 'first-episode psychosis,' it is essential to perform a complete organic screen consistently.
CONCLUSION
Acute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism.
PubMed: 36268381
DOI: 10.1016/j.amsu.2022.104565 -
Cureus Aug 2023Myxedema coma is a rare, but potentially fatal condition due to severe hypothyroidism, and most commonly seen in patients with long standing, untreated hypothyroidism....
Myxedema coma is a rare, but potentially fatal condition due to severe hypothyroidism, and most commonly seen in patients with long standing, untreated hypothyroidism. Here, I report a case of a 75-year-old male who presented to the emergency department with acute respiratory failure and altered mental status. Interestingly, this case led to a new diagnosis of hypothyroidism presenting in its most severe form - myxedema coma. This case highlights the diagnostic challenges in identifying patients with myxedema coma and recognizing its potential role as a cause of respiratory failure.
PubMed: 37727154
DOI: 10.7759/cureus.43747 -
European Journal of Case Reports in... 2020This report describes the management of a patient with myxoedema coma masquerading as an acute stroke (with or without 'cold sepsis'). Myxoedema coma is an endocrine...
UNLABELLED
This report describes the management of a patient with myxoedema coma masquerading as an acute stroke (with or without 'cold sepsis'). Myxoedema coma is an endocrine emergency occurring when physiological adaptations to untreated hypothyroidism are overwhelmed by an acute precipitant. Even promptly treated, it has an associated mortality of up to 50%.
LEARNING POINTS
Early recognition of myxoedema coma is essential, however the chance of misdiagnosis remains high.Key management consists of rapid thyroid hormone replacement (intravenous T4 at 300-500 μg over 24 hours, followed by 50-100 μg daily), supportive measures and the concomitant management of triggers such as infection.
PubMed: 32665924
DOI: 10.12890/2020_001563 -
Cureus Jan 2023Hypothyroidism, a disorder of decreased thyroid hormone secretion diagnosed by increased thyroid stimulating hormone (TSH) and low free triiodothyronine (FT3) and free...
Hypothyroidism, a disorder of decreased thyroid hormone secretion diagnosed by increased thyroid stimulating hormone (TSH) and low free triiodothyronine (FT3) and free thyroxine (FT4) levels, is classified as primary and secondary hypothyroidism, depending on the pathology. Raised TSH levels are associated with primary hypothyroidism, while decreased levels of TSH are seen in secondary hypothyroidism. With the easy availability of diagnostic tests, hypothyroidism can be detected and managed early but can be life-threatening if not treated within time. Manifestations of hypothyroidism are dry skin, hoarseness of voice, weight gain, constipation, cold intolerance, fatigue, and lethargy; however, the clinical presentation can differ as per age and sex and person to person. Here, we present one such case, which was brought to the emergency room with a history of altered sensorium, hypotension, and swelling over the bilateral lower limbs and face, with a surprise diagnosis of myxedema crisis. The uniqueness of this case is the omnipresent availability of early diagnosis and treatment in this era. still got a female patient with altered sensorium who was diagnosed to be a myxedema crisis which was given a lesser thought in our provisional diagnosis.
PubMed: 36788845
DOI: 10.7759/cureus.33743 -
Cureus Jul 2022Thyroid hormones play a crucial role in maintaining homeostasis throughout the human body. Hypothyroidism is a result of insufficient circulating levels of thyroid...
Thyroid hormones play a crucial role in maintaining homeostasis throughout the human body. Hypothyroidism is a result of insufficient circulating levels of thyroid hormone. In a hypothyroid state, not only do all metabolic processes tend to slow down but so do neurological processes. Here, we present an interesting case of a woman with a history of severe hypothyroidism that was untreated for the past 10 years.
PubMed: 35936163
DOI: 10.7759/cureus.26595 -
Cureus Aug 2020Hypothyroidism is one of the common comorbidities seen in patients with psychiatric conditions. Sometimes few patients may present with neuropsychiatric symptoms such as...
Hypothyroidism is one of the common comorbidities seen in patients with psychiatric conditions. Sometimes few patients may present with neuropsychiatric symptoms such as cognitive slowing, depression, or psychosis ("myxedema madness"). These patients are managed with antipsychotic medications while admitting laboratory works are processed. It has been found that antipsychotic use is associated with lower free thyroxine levels, so untreated hypothyroid patients may experience worsening of symptoms with antipsychotic use. It is recommended that hypothyroid patients with psychosis be treated for the underlying hypothyroidism with thyroid hormone replacement. In this article, we are presenting a case of a hypothyroid patient presenting to a psychiatric facility for worsening psychosis and persecutory delusions, and medication non-compliance to levothyroxine. We also discuss the management of psychosis in a patient with worsening hypothyroidism with a combination regimen: levothyroxine and risperidone.
PubMed: 33014650
DOI: 10.7759/cureus.10152 -
Cureus Jun 2022Myxedema coma is a medical emergency with a high mortality rate. Patients with hypothyroidism may develop myxedema coma if left untreated, although quite rare nowadays...
Myxedema coma is a medical emergency with a high mortality rate. Patients with hypothyroidism may develop myxedema coma if left untreated, although quite rare nowadays owing to regular TSH (thyroid stimulating hormone) monitoring. We present the case of a patient with a known history of subclinical hypothyroidism, defined by normal free T4 (thyroxine) and high TSH, who was found to be in myxedema coma. Clinically, the patient was found to be lethargic, bradycardic, and hypothermic, and in the background of high TSH, myxedema coma was suspected. The patient was admitted to the ICU (Intensive Care Unit) and initially treated with intravenous (IV) hydrocortisone for possible concomitant adrenal insufficiency. This was followed by treatment with IV levothyroxine.
PubMed: 35795505
DOI: 10.7759/cureus.25588 -
Case Reports in Veterinary Medicine 2021A 9-year-old male intact mixed-breed dog was presented to The Ohio State University Veterinary Medical Center for evaluation of two days' duration of weakness, lethargy,...
A 9-year-old male intact mixed-breed dog was presented to The Ohio State University Veterinary Medical Center for evaluation of two days' duration of weakness, lethargy, inappetence, and one episode of vomiting the day of presentation. On presentation, the dog was depressed and tetraparetic. He was noted to be icteric and dehydrated. Obesity and truncal alopecia with a "rat tail" appearance were observed. Diagnostic testing revealed evidence of an acute hepatopathy and peritonitis. Given the dog's neurologic status, physical examination abnormalities, including a "tragic facial expression", and hyperlipidemia, there was concern for possible myxedema coma. A thyroid panel was consistent with hypothyroidism. The dog experienced respiratory arrest prior to initiation of therapy, and an autopsy confirmed the presence of subacute necrotizing cholangiohepatitis, marked atherosclerosis, and severe thyroid atrophy. These clinical and pathologic changes were supportive of myxedema coma.
PubMed: 34745683
DOI: 10.1155/2021/6622767 -
Journal of Acute Medicine Jun 2021Lithium intoxication-induced myxedema coma, a rare but dangerous condition of severe hypothyroidism, can be easily misdiagnosed in patients without history of...
Lithium intoxication-induced myxedema coma, a rare but dangerous condition of severe hypothyroidism, can be easily misdiagnosed in patients without history of hypothyroidism. The objective of this case report is to describe a lithium-treated patient who presented to emergency department with obtundation and moderate hypothermia and was diagnosed with myxedema coma and lithium toxicity. A 64-year-old female presented to the emergency department with obtundation and hypothermia. The patient had the past history of stage-III chronic kidney disease, bipolar-type schizoaffective disorder, hypertension, and hyperlipidemia, and she had received long-term lithium therapy for the schizoaffective disorder. Bradycardia with hypotension developed after a few hours of admission and thyroid function revealed thyroid-stimulating hormone 53.1 nIU/mL and free T4 (FT4) 0.11 ng/dL, and the serum lithium level was 2.54 mmol/L. Therefore, diagnosis of lithium intoxication-induced myxedema coma was made, and the patient was managed with oral form of levothyroxine (LT4) (loading dose of 400 mcg followed by 100 mcg per day), intensive fluid therapy, empirical antibiotics, mechanical ventilation, and inotropic agents; lithium had been discontinued since admission. The patient weaned from the mechanical ventilation and inotropic support at day 4 of admission and by day 6, the patient's consciousness had fully recovered; on day 9, the serum lithium level was 0.37 mmol/L. The patient's FT4 recovered to the normal range (0.96 ng/dL) on day 15. In patients with no history of hypothyroidism or neck surgery and radiation therapy, lithium intoxication can be the single contributor to myxedema coma, which can be treated with oral form of LT4 as thyroid replacement therapy with instant and intensive supportive care. However, further study is needed to compare the outcomes of the patients with myxedema coma treated by oral and intravenous LT4.
PubMed: 34295637
DOI: 10.6705/j.jacme.202106_11(2).0004