Find out here why myxedema occurs, and the symptoms. Joslin 17 and others 27 stated that the presence of acetone or diacetic acid in the urine was requisite for the diagnosis of diabetic coma. University of michigan rogel cancer center bladder cancer handbook. Early recognition and therapy of myxedema coma are essential. Hypothyroidism a booklet for patients and their families. A person may have lab values identical to a normal hypothyroid state, but a stressful event such as an infection, myocardial infarction or stroke precipitates the myxedema coma state, usually in the elderly. The paucity of cases may be due to either underreporting or improvement in the diagnosis and treatment of uncomplicated hypothyroidism. Among 203 patients who had chronic critical illness and were admitted to a respiratory care unit, 61 30% were comatose 22. Clinical practice guidelines for hypothyroidism in adults. When we spoke to our state representative, william oberle, he understood our concerns and enthusiastically supported the idea of the coma guide for caregivers.
Treatment should be initiated on the basis of clinical suspicion without waiting for laboratory results. Nevertheless, although the need to treat these patients with thyroid hormone is so patently obvious, the regimen by which to conduct this treatment remains somewhat controversial. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Hypothyroidism as a clinical syndrome was described in 1874 by gull under the name of myxedema in view of the swollen skin and its excessive content of mucin myx. Symptoms can manifest in all organ systems and range in severity based on the degree of hormone deficiency. Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism. Clinical endocrinologists worldwide rely on endocrine practice, the official journal of the american association of clinical endocrinologists aace, to keep them on the leading edge of treatment of patients with endocrine diseases. Patients with myxedema coma should be managed in an intensive care unit with continuous cardiac monitoring. Myxedema coma is the ultimate stage of severe longstanding hypothyroidism. Guidance for the treatment of deep vein thrombosis and.
Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Coma, delirium, and cognitive dysfunction in critical illness. Coma recovery scalerevised 2004 administration and scoring guidelines joseph t. Wijdicks, mdb introduction many patients present to the emergency department with an alteration in mental status simply as a complication of many serious illnesses.
Hypothyroidism is a frequently diagnosed and simply treated disease. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than frankly comatose. About a quarter of a million patients are treated for traumatic brain injury. Treatment of diabetic ketoacidosis dkahyperglycemic. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. Myxedema coma is an endocrinologic emergency and is the most clinically severe form of hypothyroidism. Diabetic coma occurs when blood sugar gets too high and the body becomes severely dehydrated. T he neurologist is often required to evaluate the unconscious patient from both the diagnostic and prognostic perspective. Aspen hill maryland physician directory myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. Depending on the type of injury, immediate treatment may be lifesaving. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. Patients are often placed in the intensive care unit for continuous monitoring and treatment. Brain injury can be due to increased pressure, bleeding, loss of oxygen, or. Prompt initiation of an effective regimen is vitally important and so using any one of the effective regimens that readily at.
Your bladder is a hollow muscular organ in the lower abdomen. In 1883, semon noted striking similarities between patients with myxedema and. Patients with hypothyroidism may exhibit a number of physiologic alterations to. Myxedema coma is a medical emergency that requires immediate attention. Burman, in clinical management of thyroid disease, 2009. Myxedema coma is a rare syndrome that represents the extreme expression of severe, longstanding hypothyroidism. The question is how to restore the low serum and tissue thyroid hormone concentrations to. Myxedema coma treatment, symptoms, causes, diagnosis.
Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. Novel advances in the management of hyperglycemic crises uk versus usa ketan k. Primary treatment is prompted by the administration of adequate doses of either the thyroid hormone lthyroxine given intravenously or by giving liothyronine via a nasogastric tube. In patients with myxedema coma, an effective approach consists of the following.
Hypothyroidism a booklet for patients and their families a publication of the american thyroid association ata. However, despite the ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a challenge. Mild myxedema coma usually is treated by a general practitioner or internist while moderate to severe myxedema coma is treated and managed by an endocrinologist. Senior physicians must be involved early in the care of an unconscious. Myxedema coma is the most severe manifestation of hypothyroidism. Without a rapid diagnosis, myxedema crisis is often fatal. Neurological assessment of coma journal of neurology. Which patients require hospitalization versus initial outpatient therapy for the management of vte.
We had no such guide or central place where comprehensive information and resources on coma could be easily obtained. The construct of myxedema coma sets clinicians up for diagnostic failure. Treatment of myxedema coma with intravenous thyroxine. Approach to the patient with coma vanderbilt university medical. Decompensated hypothyroidism may be conceptualized as hypothyroidism causing organ failure. Signs and symptoms include hypothermia, bradycardia, altered mental status. Pdf treatment of myxedema coma after major thoracic. Sedation, confusion, delirium, ataxia, coma, apnea.
Myxedema coma is a state of decompensated hypothyroidism. The mortality rates may be as high as 25 to 60 percent even with treatment. Myxedema refers to both a form of severe hypothyroidism and a number of effects that hypothyroidism can have on the skin and other body tissues. Toxidromes and drug overdose management will coolidge pharmd, bcccp critical careemergency medicine. Guidelines american association of clinical endocrinologists. Treatment of diabetic ketoacidosis dkahyperglycemic hyperosmolar state hhs.
Treatment for people in a coma will depend on the severity and cause of the. A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened. Initial diagnosis and management of coma stephen j. Coma guide for caregivers delaware health and social services. Generally, myxedema coma requires several years of untreated hypothyroidism to develop, and usually, it occurs in elderly people who have been without medical care. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis due to the high associated mortality rate. It can happen as a result of a traumatic accident, such as a blow to the head, or a medical condition, for example, some types of infection. Unconscious, coma, neurological injury, hypoglycaemia, drug toxicity. Hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. Treatment of myxedema coma after major thoracic surgery. In addition, any of the regimens listed below for the treatment of chloroquine resistant malaria may be used for the treatment of chloroquinesensitive malaria. This syndrome has been seen very rarely following the use of ivermectin. The goals of treatment are to provide frequent patient monitoring, to treat the underlying cause and to gradually and safely. Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death.
Early diagnosis, rapid administration of thyroid hormones and adequate supportive. A subset of these patients will present comatose, a clinical state that is a true medical emergency. Treatment of myxedema coma with intravenous thyroxine david n. Myxedema coma definition, symptoms, causes, treatment. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma. It was later hypothesized that diabetic coma with negative urinary ketones was the result of impaired renal excre. Response in coma and other low responsive patients pdf. This section covers recommendations for hospitalized patients with hypothyroidism and use of thyroid hormone analogs. Before we get much further, it is important for us to note that there have been recent advancements in terminology, which have\.
During this period 51 cases were re ported in englishlanguage journals. Part iv in a series covering the american thyroid association guideline on the treatment of hypothyroidism. A systematic approach to the unconscious patient ncbi. Center for head injuries edison, new jersey johnson rehabilitation institution affiliated with jfk medical center updated 11105. Webmd tells you the symptoms to look out for and how its treated. It stores urine, the liquid waste made by the kidneys. What is the role of glucocorticoid therapy in the treatment of myxedema coma crisis. The other rationale for the treatment with corticosteroids is the potential risk of precipitating acute. If not recognised, however, in time it may develop into the most severe manifestation of hypothyroidism known as myxedema coma. Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition.
Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. Urine passes from each kidney into the bladder through a long tube called a ureter. Myxedema and coma severe hypothyroidism endotext ncbi. This article is published with open access at abstract. Knowledge of the anatomical basis of coma is essential for competent evaluation but must be combined with an understanding of the many, often multifactorial, medical conditions that result in impaired consciousness. Thomas dowling, md seattle although coma as a terminal manifestation of myxedema was first described in 1879, it received little further emphasis until the last decade. Internationally respected endocrine practice is the journal for clinical endocrinologists. It is essential to identify and treat the condition precipitating the coma. Important clues to the possible presence of myxedema coma in a poorly responsive patient are the presence of a thyroidectomy scar or a history of radioiodine therapy or.
114 960 1555 1604 25 1589 1529 847 758 1287 1636 1371 1331 1475 89 56 1303 1240 342 45 975 873 1321 1416 141 191 521 1029 417 464 879 887 1593 538 1422 981 369 425 501 594 1099 101 1209 1405 801