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 μg/d gastric tube),
- preventively antibiotics, heart failure therapy, gradual warming,
- ALV (in respiratory insufficiency ), pacing (in severe bradycardia).
Links
Related articles
References
- KLENER, P, et al. Vnitřní lékařství. 3. edition. Prague : Galén, 2006. ISBN 80-7262-430-X.
- DÍTĚ, P., et al. Vnitřní lékařství. 2. edition. Prague : Galén, 2007. ISBN 978-80-7262-496-6.
