A Delayed Diagnosis of Myxedema Coma

Williams, Carla

doi:10.7759/cureus.33370

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…To illustrate this, consider the case of chronic kidney disease (CKD). This high-mortality condition has attracted consequential debate over the use of so-called race correction factors to adjust for differences in prevalence between Blacks and non-Blacks 51 . Most initial diagnosis is by way of screening for serum creatinine, high levels of which are a biomarker for low estimated glomerular filtration rate and hence impaired kidney function.…”

Section: Discussionmentioning

confidence: 99%

Dual exposure-by-polygenic score interactions highlight disparities across social groups in the proportion needed to benefit

Nagpal,

Gibson

2024

Preprint

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The transferability of polygenic scores across population groups is a major concern with respect to the equitable clinical implementation of genomic medicine. Since genetic associations are identified relative to the population mean, inevitably differences in disease or trait prevalence among social strata influence the relationship between PGS and risk. Here we quantify the magnitude of PGS-by-Exposure (PGSxE) interactions for seven human diseases (coronary artery disease, type 2 diabetes, obesity thresholded to body mass index and to waist-to-hip ratio, inflammatory bowel disease, chronic kidney disease, and asthma) and pairs of 75 exposures in the White-British subset of the UK Biobank study (n=408,801). Across 24,198 PGSxE models, 746 (3.1%) were significant by two criteria, at least three-fold more than expected by chance under each criterion. Predictive accuracy is significantly improved in the high-risk exposures and by including interaction terms with effects as large as those documented for low transferability of PGS across ancestries. The predominant mechanism for PGSxE interactions is shown to be amplification of genetic effects in the presence of adverse exposures such as low polyunsaturated fatty acids, mediators of obesity, and social determinants of ill health. We introduce the notion of the proportion needed to benefit (PNB) which is the cumulative number needed to treat across the range of the PGS and show that typically this is halved in the 70th to 80th percentile. These findings emphasize how individuals experiencing adverse exposures stand to preferentially benefit from interventions that may reduce risk, and highlight the need for more comprehensive sampling across socioeconomic groups in the performance of genome-wide association studies.

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Section: Discussionmentioning

confidence: 99%

Dual exposure-by-polygenic score interactions highlight disparities across social groups in the proportion needed to benefit

Nagpal,

Gibson

2024

Preprint

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“…This condition, affecting 0.22 individuals per million annually, predominantly targets women over the age of 60 [ 6 ]. Up to a quarter of affected patients may undergo either focal or generalized seizures, with potential signs of hypothermia, electrocardiographic abnormalities, cardiomegaly, decreased cardiac output, and hypotension [ 7 ]. In certain instances, myxedema can cause respiratory depression and gastrointestinal issues like anorexia, abdominal pain, constipation, fecal retention, and paralytic ileus [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Amiodarone-Induced Myxedema Coma in Elderly Patients: A Systematic Review of Case Reports

Alnaeem¹,

Suleiman²,

Mansour³

et al. 2023

Cureus

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This systematic review aimed to explore whether elderly patients administered amiodarone were susceptible to developing myxedema coma. Utilizing the Cochrane guidelines, a comprehensive review of databases such as Medline (PubMed), Science Direct, CINAHL Cochrane, and Google Scholar was undertaken to examine case reports on amiodarone-induced myxedema coma. Following stringent criteria for inclusion, 12 pertinent case reports were identified. These findings suggested a high probability of myxedema coma development in patients who had been administered amiodarone. Specifically, patients who received an oral dosage of 100-200 mg of amiodarone were reported to have developed bradycardia and hypothermia alongside elevated thyroid-stimulating hormone (TSH) levels. Upon diagnosis, the majority of patients were treated with a regimen of levothyroxine and hydrocortisone medication. Despite the myriad potential causes of myxedema coma complicating the diagnosis, it was found that through a combination of clinical symptoms and serum TSH measurements, a confirmed diagnosis could be reached. Furthermore, it was observed that amiodarone-induced myxedema coma responded favorably to treatment with levothyroxine and glucocorticoids.

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A Delayed Diagnosis of Myxedema Coma

Cited by 2 publications

References 5 publications

Dual exposure-by-polygenic score interactions highlight disparities across social groups in the proportion needed to benefit

Dual exposure-by-polygenic score interactions highlight disparities across social groups in the proportion needed to benefit

Amiodarone-Induced Myxedema Coma in Elderly Patients: A Systematic Review of Case Reports

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