Myxedema Coma

Myxedema coma is the escalation of the symptoms of hypothyroidism into a life-threatening condition.

Etiology
Untreated or poorly treated hypothyroidism + provocative moment (stress, cold, infection, injury, surgery, medication, alcohol).

Klinical picture

 * Decrease in body temperature (up to 30 °C),
 * hypoventilation + increased retention CO2,
 * extreme drowsiness; gradually progresses to coma,
 * bradycardia,
 * hyponatremia + hypercapnia → arrhythmia → hert failure + cardiac arrest.

Diagnostics

 * In peripheral etiology significantly ↑ TSH + ↓ fT4, hypercapnia, ↓ Na+ + Cl-, ↑ CK, liver function tests, LDH,
 * assessment cortizol + ACTH.

Therapy

 * Glucocorticoids (e.g. hydrocortisone 100 mg i.v./d – current renal insufficiency cannot be excluded in most patients),
 * adjustment of water + electrolyte balance,
 * levothyroxine (200–500 &mu;g/d gastric tube),
 * preventively antibiotics, heart failure therapy, gradual warming,
 * ALV (in respiratory insufficiency ), pacing (in severe bradycardia).

Related articles

 * Coma
 * Hypothalamus
 * Thyroid gland