Once the disease has progressed to myxedema coma, the mortality rate may exceed 20% in the treated population. Guidelines american association of clinical endocrinologists. Though not common, this advanced stage is more life threatening than the earlier stages. To develop diagnostic criteria for myxedema coma mc, a decompensated state of extreme hypothyroidism with a high mortality rate if untreated, in order to facilitate its early recognition and treatment. This disease can be managed with synthetic hormone supplementation and has an excellent prognosis. Treatment should be started when a patient presents with coma and chronic kidney disease with or without dialysis, even in the absence of hypotension, hypothermia, hyponatremia, and hypoxemia.
Oct 10, 2018 myxedema coma, occasionally called myxedema crisis, is a rare lifethreatening clinical condition that represents severe hypothyroidism with physiological decompensation. It is a medical emergency and, even with early diagnosis and treatment, the mortality can be as high as 60%. Myxedema coma treatment, symptoms, causes, diagnosis. Intravenous thyroid hormone therapy replacement is the cornerstone in the treatment of patients. Myxedema coma, occasionally called myxedema crisis, is a rare lifethreatening clinical condition that represents severe hypothyroidism with physiological decompensation. Myxedema coma mc is defined as an extreme, uncommon and lifethreatening manifestation of hypothyroidism characterized by a marked and general decompensation. The mortality rates may be as high as 25 to 60 percent even with treatment. A subset of these patients will present comatose, a clinical state that is a true medical emergency. Myxedema crisis can be treated and managed if it is diagnosed early. Mar 24, 2020 hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. Treatment of myxedema coma should be immediately initiated once the diagnosis is suspected, even without laboratory confirmation. Myxedema definition, symptoms, what is, treatment, pictures. Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death.
The prognosis, however, remains poor with a reported mortality between 20% and 50%. However, despite the ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a challenge. May 31, 2017 myxedema coma, also known simply as myxedema, is a rare but potentially deadly manifestation of severe hypothyroidism. Clinical features of myxedema coma myxedema coma is a rare syndrome that represents the extreme expression of severe, longstanding hypothyroidism. The high mortality rate of 2550 % makes early diagnosis and treatment imperative 1, 2. Myxoedema comacrisis, hypothyroidism, chronic kidney disease ckd, nephrotic syndrome.
Early diagnosis, rapid administration of thyroid hormones and adequate supportive measures table are essential for a successful outcome. Without a rapid diagnosis, myxedema crisis is often fatal. Signs and symptoms include hypothermia, bradycardia, altered mental status. Jul 06, 2017 without a rapid diagnosis, myxedema crisis is often fatal. In a severely hypothyroid individual, a myxedema coma tends to be triggered by severe illness, surgery, stress, or traumatic injury. Burman, in clinical management of thyroid disease, 2009. Symptoms can manifest in all organ systems and range in severity based on the degree of hormone deficiency. The frequencies of characteristics associated with mc were assessed retrospectively in patients from our institutions in order to derive a semiquantitative diagnostic point. Long periods of low thyroid hormones may lead to a fatal condition known as myxedema coma.
It is a lifethreatening complication with a mortality rate of 2560 percent and tends to affect older adults. Hypothyroidism and myxedema coma differential diagnoses. Pdf raionale myxedema coma mc is extremely rare but lethal in pediatric patients with. It is a medical emergency with a high mortality rate. It can be brought about by removal of the thyroid for any cause, by a cessation of function of the gland, or simply by glandular atrophy. Myxedema coma, a rare yet fatal disease, can present clinicians with a diagnostic dilemma because patients pre sent with altered consciousness rather. Therefore, myxedema coma must be considered in the differential diagnosis. Myxedema coma is an endocrinologic emergency and is the most clinically severe form of hypothyroidism. You should call emergency medical services if you or a person you know develops signs of myxedema coma. Myxedema can occur in the lower leg pretibial myxedema and behind the eyes exophthalmos. Myxedema and coma severe hypothyroidism endotext ncbi.
Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing. This condition requires hospitalization and immediate treatment with thyroid hormones given by injection. Myxedema, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult. Myxedema coma, also known simply as myxedema, is a rare but potentially deadly manifestation of severe hypothyroidism. 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.
This paper describes evidencebased clinical guidelines for the clinical management of hypothyroidism in ambulatory patients. Myxedema coma is a severe form of hypothyroidism low thyroid function. Elderly people are at a higher risk of having a poor outcome. Myxedema is a term used synonymously with severe hypothyroidism. Thyroid hormone levels are similar to those found in uncomplicated hypothyroidism. Most people tend to ignore the condition, ruling out its severity, but if the condition remains untreated for long time it might become deadly. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread. Physicians should include hypothyroidism in the differential diagnosis of every patient with hyponatremia. Myxedema is known to occur in various forms of hyperthyroidism, including graves disease. Ckd, its diagnosis may be delayed in patients who have concomitant ckd. May 22, 2018 myxedema coma is a rare but severe complication of myxedema.
Sep 03, 2019 treatment of myxedema coma should be immediately initiated once the diagnosis is suspected, even without laboratory confirmation. Apr 16, 2014 myxoedema coma can be regarded as a form of decompensated hypothyroidism in which the adaptations of the body to untreated hypothyroidism fail to maintain homoeostasis and become overwhelmed by hypothermia, infection or other precipitating factors. Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. Treatment begins with intravenous levothyroxine and intravenous hydrocortisone until associated adrenal. The condition is seen typically in elderly women and is often precipitated by infection, medication, environmental exposure, or other metabolicrelated stresses. The diagnosis of myxedema coma is made when the three key diagnostic features of myxedema coma are present, which include altered mental status, hypothermia or absence of fever and a precipitating event such as cold exposure, infection, drugs. Myxedema coma discharge care what you need to know.
Initial diagnosis and management of coma stephen j. Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. If not recognised, however, in time it may develop into the most severe manifestation of hypothyroidism known as myxedema coma. Dec 26, 2018 myxedema crisis or coma, is a rare and potentially fatal condition caused by low levels of thyroid hormones produced by the thyroid gland. Instead, the diagnostic coding for these patients included. Myxedema coma, the most severe form of hypothyroidism, is rare. Dec 01, 2000 while myxedema coma carries a significant mortality rate even with appropriate testing and treatment, an early diagnosis of hypothyroidism may well save a patients life. Myxedema coma is a rare and potentially fatal manifestation of severe hypothyroidism that can be successfully treated using intravenous levothyroxine. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. The prognosis of myxedema coma may include the duration of myxedema coma, chances of complications of myxedema coma, probable outcomes, prospects for recovery, recovery period for myxedema coma, survival rates, death rates, and other outcome possibilities in the overall prognosis of myxedema coma. Decompensated hypothyroidism myxedema coma emcrit project. Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling.
Wijdicks, mdb introduction many patients present to the emergency department with an alteration in mental status simply as a complication of many serious illnesses. It is one of the most urgent and lethal endocrine conditions. Hypothyroidism after 1 i treatment for toxic nodular goiter is less common 6% to %. Ono y, ono s, yasunaga h, matsui h, fushimi k, tanaka y. Early diagnosis, rapid administration of thyroid hormones and adequate supportive.
Myxedema consists of tissue swelling, fluid buildup in the heart and lungs, slowed muscle reflexes, and problems with thinking skills. Myxedematous coma is a syndrome that results from the intense reduction of the thyroid hormone synthesis. Patients are often placed in the intensive care unit for continuous monitoring and treatment. These adaptations include peripheral vasoconstriction to maintain core body temperature. Thyroid hormones may be measured every 1 to 2 days. Hypothyroidism has multiple etiologies and manifestations. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions. Early diagnosis and treatment is the solution to avoiding the only potentially life threatening complication of untreated hypothyroidism that is myxedema coma. Myxedema coma is a rare, lifethreatening condition, occurs late in the progression of hypothyroidism. It occurs when thyroid hormone levels are extremely low. All patients with an admitting diagnosis of myxedema coma recorded in their charts between january 1, 2005 and june, 2010 were identified. Because most atrisk patients, including those with known hypothyroidism, thyroidectomy or previous radioactive iodine therapy, are routinely followed by readily available tsh.
Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory failure from. A diagnostic scoring system for myxedema coma endocrine. Myxedema coma definition, symptoms, causes, treatment. The paucity of cases may be due to either underreporting or improvement in the diagnosis and treatment of uncomplicated hypothyroidism. In myxedema coma the breathing slows, the person has seizures and blood supply to the brain is decreased. In this latter sense, myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. Myxedema comacrisis occurs most commonly in older women with longstanding, undiagnosed or under treated hypothyroidism who experience an additionalsignificant stress,such asinfection,a. Management consists of supportive therapy, hormone replacement, and treatment of precipitating factors 1,3,4. Myxedema coma can be triggered by not taking medicine to treat hypothyroidism. Thyroid hormones help control body temperature, heart rate, growth, and weight. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. Myxedema crisis is a severe life threatening form of decompensated.
Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma. Hypothyroidism myxedema nursing care plan and management. It may be caused by an infection, illness, exposure to cold, or certain medications in people with untreated hypothyroidism. The therapeutic endpoints of levothyroxine therapy in patients with myxedema coma should be improved mental status, improved cardiac function, and improved pulmonary function. Diagnosis of myxedema coma complicated by renal failure. What is the role of glucocorticoid therapy in the treatment.
Myxedema coma is primarily a clinical diagnosis with features of uncomplicated hypothyroidism but more exaggerated. Myxedema coma symptoms, diagnosis, treatments and causes. However, the term is also used to describe a dermatological change that can occur in hyperthyroidism and rare paradoxical cases of hypothyroidism. Myxedema coma occurs when thyroid hormone levels are not treated or controlled. Cases of myxedema coma usually occur in women with a significant mortality rate 2560% even when they are under proper treatment 2,3. Myxedema coma as a t rue medical emergency requires a multifaceted approach to treatment in a critical care setting treatment should be instituted in patients with presumed myxedema coma. Myxedema coma is a rare but severe complication of myxedema. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory. Hypothyroidism is a frequently diagnosed and simply treated disease. Case report, diagnosis, emergency, myxedema coma, renal failure. Clinical characteristics and outcomes of myxedema coma.
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