Clinical features of myxedema coma
- Classic combination of AMS and hypothermia but may also manifest with:
- hypotension, bradycardia
- hyponatremia, hypoglycemia
- Non-pitting edema of the hands/feet/face and enlarged tongue (abnormal deposits of mucin)
- Often precipitated by infection, cessation of thyroid replacement, ACS
Posted 07/14/16 02:24:29 PM by Matthew Cummings
- Extensive scoring system exists surrounding above criteria but derived from small sample size (21 patients), thus...
- MUST consider in any altered patient w/ hypothermia, hyponatremia, and/or hypercapnia and send TSH, FT4, and cortisol (assessing for concomitant adrenal insufficiency)
Posted 07/14/16 02:32:22 PM by Matthew Cummings
Supportive care for myxedema coma
- Supportive care is CRUCIAL
- Hypercapnia --> NPPV (depending on mental status), mechanical ventilation
- Hypotension --> volume resuscitation
- Hypothermia --> rewarming in monitored setting (at risk for hyperkalemia, arrhythmias)
- Hyponatremia --> frequent BMPs, appropriate correction
- Precipitant --> pan-culture/abx, EKG/troponin/TTE, etc
- Glucocorticoid administration: treat empirically w/ "stress" dose hydrocortisone (100mg q8h) until can rule out adrenal insufficiency
- Therefore important to send cortisol early prior to treatment if possible
Posted 07/14/16 02:37:05 PM by Matthew Cummings
Thyroid replacement strategies --> controversial issue (limited prospective clinical data)
- Debate as to benefit of administering BOTH T3/T4 or just T4
- Always prefer IV therapy (poor GI absorption in myxedema)
- T4 (levothyroxine): loading doses usually begin ~200mcg and then daily dose of ~1.5mcg/kg/day
- T3 (liothyronine): loading doses begin ~5mcg, and then daily doses starting at 2.5mcg q8h
- Prefer lower doses in elderly, underweight patients and those w/ arrhythmia, ACS, CHF)
Posted 07/14/16 02:46:19 PM by Matthew Cummings
For further reading...
Posted 07/14/16 06:16:47 PM by Matthew Cummings
Created by Christopher Kelly
Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.