-
Medicina 2017Hypothyroidism is a frequently diagnosed and simply treated disease. If not recognised, however, in time it may develop into the most severe manifestation of... (Review)
Review
Hypothyroidism is a frequently diagnosed and simply treated disease. If not recognised, however, in time it may develop into the most severe manifestation of hypothyroidism known as myxedema coma. The term "myxedema coma" is generally seen as misleading since most patients do not initially present in a coma. The typical progression is lethargy evolving into stupor and, eventually, into coma with respiratory failure and hypothermia. It mainly affects elderly women, often occurring in winter and is relatively rare. It can be considered a form of decompensated hypothyroidism often triggered by a variety of non-thyroid conditions or diseases provoking an extremely severe condition of multiple system failure with lethal consequences unless an early diagnosis is made and an aggressive treatment is administered.
Topics: Coma; Disease Progression; Humans; Hypothyroidism; Myxedema
PubMed: 28825577
DOI: No ID Found -
Journal of Intensive Care Medicine 2007Untreated or unrecognized hypothyroidism may progress to severe decompensated hypothyroidism or myxedema coma. Relatively few cases are reported in the literature since... (Review)
Review
Untreated or unrecognized hypothyroidism may progress to severe decompensated hypothyroidism or myxedema coma. Relatively few cases are reported in the literature since the first case was apparently reported from the St. Thomas Hospital in London in 1879. The paucity of cases may be due to either underreporting or improvement in the diagnosis and treatment of uncomplicated hypothyroidism. However, despite the ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a challenge. Although thyroid hormone treatment is highly effective when combined with ventilatory and hemodynamic support in the intensive care unit setting, controversies abound on the optimal and most effective choice of thyroid hormone preparation: thyroxine and triiodothyronine and in what amount. Accumulated evidence now shows that proper use of either thyroxine alone or in combination with triiodothyronine may be effective therapy.
Topics: Coma; Humans; Hypothyroidism; Myxedema
PubMed: 17712058
DOI: 10.1177/0885066607301361 -
Reviews in Endocrine & Metabolic... May 2003
Review
Topics: Coma; Humans; Myxedema; Thyroid Function Tests; Thyroid Hormones
PubMed: 12766541
DOI: 10.1023/a:1022985902253 -
Journal of Cutaneous Medicine and... 2022
Topics: Elephantiasis; Humans; Leg Dermatoses; Myxedema
PubMed: 33657829
DOI: 10.1177/1203475421995717 -
Nihon Rinsho. Japanese Journal of... May 2006
Review
Topics: Coma; Critical Care; Diagnosis, Differential; Glucocorticoids; Humans; Hypothyroidism; Myxedema; Prognosis; Thyroid Hormones
PubMed: 16776161
DOI: No ID Found -
The Lancet. Diabetes & Endocrinology Jul 2014
Topics: Humans; Male; Middle Aged; Myxedema
PubMed: 24931819
DOI: 10.1016/S2213-8587(14)70063-4 -
Critical Care Clinics Jan 1991Myxedema coma is a rare condition associated with high mortality. The pathophysiology is complex and often involves profound hypothyroidism as well as an inciting event.... (Review)
Review
Myxedema coma is a rare condition associated with high mortality. The pathophysiology is complex and often involves profound hypothyroidism as well as an inciting event. The diagnosis should be suspected based on the clinical presentation, and treatment should not be delayed while awaiting confirmatory laboratory data. In critically ill patients, laboratory differentiation between severe hypothyroidism and the euthyroid-sick syndromes is difficult and may require measurement of free hormone levels. Treatment consists of correction of electrolyte abnormalities, passive rewarming, treatment of infections, respiratory and hemodynamic support, administration of stress-dose glucocorticoids, and thyroid hormone replacement. Intravenous thyroxine, between 200 and 500 micrograms as the initial dose followed by 50 to 100 micrograms/day, is recommended. Concurrent therapy with triiodothyronine can also be considered.
Topics: Coma; Female; Humans; Middle Aged; Myxedema
PubMed: 2007219
DOI: No ID Found -
Postgraduate Medical Journal Aug 2021
Topics: Exophthalmos; Humans; Myxedema; Osteoarthropathy, Secondary Hypertrophic; Syndrome
PubMed: 32962982
DOI: 10.1136/postgradmedj-2020-138668 -
Polish Archives of Internal Medicine Aug 2019Myxedema coma and thyroid storm are among the most common endocrine emergencies presenting to general hospitals. Myxedema coma represents the most extreme,... (Review)
Review
Myxedema coma and thyroid storm are among the most common endocrine emergencies presenting to general hospitals. Myxedema coma represents the most extreme, life‑threatening expression of severe hypothyroidism, with patients showing deteriorating mental status, hypothermia, and multiple organ system abnormalities. It typically appears in patients with preexisting hypothyroidism via a common pathway of respiratory decompensation with carbon dioxide narcosis leading to coma. Without early and appropriate therapy, the outcome is often fatal. The diagnosis is based on history and physical findings at presentation and not on any objective thyroid laboratory test. Clinically based scoring systems have been proposed to aid in the diagnosis. While it is a relatively rare syndrome, the typical patient is an elderly woman (thyroid hypofunction being much more common in women) who may or may not have a history of previously diagnosed or treated thyroid dysfunction. Thyrotoxic storm or thyroid crisis is also a rare condition, established on the basis of a clinical diagnosis. The diagnosis is based on the presence of severe hyperthyroidism accompanied by elements of systemic decompensation. Considering that mortality is high without aggressive treatment, therapy must be initiated as early as possible in a critical care setting. The diagnosis cannot be established based on laboratory tests alone, but several scoring systems are available. The usual clinical signs and symptoms of hyperthyroidism are present along with more exaggerated clinical manifestations affecting the cardiovascular, gastrointestinal, and central nervous systems. A multipronged approach has been recommended and has been associated with improved outcomes.
Topics: Critical Care; Emergencies; Humans; Myxedema; Thyroid Crisis; Thyroid Function Tests
PubMed: 31237256
DOI: 10.20452/pamw.14876 -
QJM : Monthly Journal of the... Dec 2015
Topics: Adult; Graves Disease; Humans; Leg Dermatoses; Male; Myxedema
PubMed: 26231090
DOI: 10.1093/qjmed/hcv136