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                Myxedema coma

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[Up] [Hypothyroidism classification] [Risk factors] [Clinical features] [End organ impact] [Associated illnesses] [Diagnosis] [Treatment] [Dose titration] [Drug interactions] [Monitoring & follow up] [Myxedema coma]

 

 

Myxedema coma occurs as an extreme manifestation of severe hypothyroidism, seen in patients with long standing hypothyroidism that is untreated.

 

 Precipitating events

  • Cold months

  • Pulmonary events

  • Cerebrovascular accidents

  • Congestive heart failure

  • Metabolic derangements

  • Drugs- sedatives, narcotics, antidepressants

 

 Cardinal Features

  • Hypothermia

  • Unconsciousness

  • Other signs of hypothyroidism

 

 Treatment 

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Treatment of underlying cause 

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Ventillatory support 

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Correction of electrolyte imbalance, hypothermia, hypotension.

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Steroid treatment -Inj Hydrocortisone 100mg, 8 hourly parenterally during initial 7 -10 days then tapered off .

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Once patient is stable, consider evaluation of adrenal status.

 

 Thyroid Hormone Therapy (Thyroxine Sodium) 

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Initial dose (loading dose ), 100-500mcg followed by maintenance dose of 50-100mcg/day.

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Parenteral preparations if not available, thyroxin tablets to be used through nasogastric tube, 500- 1000 mcg initial dose followed by 50-100 mcg /day. 

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Care to be taken if patient has ischemic heart disease.

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Due to illness, T4 given may not be converted to T3 so some advise T3 therapy

 

 T3 treatment: Quick onset of action

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Bolus IV (Triiodothyronine) T3 20mcg, followed by 10 mcg of T3 for first 24 hours and 10 mcg 6 hourly for next 2-3 days, then oral administration is started once patient is stable. 

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However intravenous T3 therapy is marked by large and unpredictable fluctuations in serum T3 levels and is dangerous to the cardiac status.

 

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Some advocate combination of T3 and T4 treatment

 

 

 

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