Myxoedema coma: a forgotten presentation of extreme hypothyroidism

Gish, David; Loynd, Richard; Melnick, Sharon B.; Nazir, Salik

doi:10.1136/bcr-2016-216225

Cited by 7 publications

(7 citation statements)

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“…It is usually precipitated by infections, heart failure, myocardial infarction, stroke, gastrointestinal bleeding and sedatives [11]. Even with early detection and appropriate treatment, mortality ranges from 30 to 60 percent [12].…”

Section: Discussionmentioning

confidence: 99%

Myxedema Coma as Initial Clinical Presentation of Empty Sella Syndrome

Sethuraman¹,

Kavitha²

2018

JCR

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Background: Myxedema coma is a medical emergency seen in patients with primary hypothyroidism. The prognosis is poor if not diagnosed and treated early. Here we report a case of secondary hypothyroidism due to empty sella syndrome presenting with initial manifestation of myxedema coma which is exceedingly rare. Case Report: A middle aged lady presented with easy fatigability for four months, giddiness for one month and vomiting for four days. Clinical diagnosis of myxedema coma was made; she was treated with levothyroxine and laboratory evaluation revealed hypo-pituitarism due to empty sella syndrome. Conclusion: Myxedema coma is an endocrine emergency seen rarely in patients with secondary hypothyroidism but early detection and management reduces the mortality.

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Section: Discussionmentioning

confidence: 99%

Myxedema Coma as Initial Clinical Presentation of Empty Sella Syndrome

Sethuraman¹,

Kavitha²

2018

JCR

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“…The recovery time after hormone replacement varied from 24 hours to 3 weeks in previous reports. [ 5 , 10 , 13 ] Hormone treatment of myxedema coma is suggested to be started intravenously because gastrointestinal absorption may be impaired in severe cases. [ 9 ] In our case oral levothyroxine rescued the patient successfully.…”

Section: Discussionmentioning

confidence: 99%

Myxedema coma

2017

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Raionale:Myxedema coma (MC) is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental status and hypothermia. But there is no clinical guideline for such cases.Patient concerns:A 6-year-old Chinese girl presented with coma and hypothermia preceded by pneumonia. Her lab results were: free thyroxin (T4) 4.18 pmol/L and thyroid-stimulating hormone (TSH) > 150 μIU/mL with extremely elevated anti-thyroid peroxidase (TPO-Ab) and anti-thyroglobulin. Pneumonia, mild pleural, and pericardial effusion were seen on computed tomographic (CT) scan.Diagnoses:MC, autoimmune hypothyroidism, pneumonia and sepsis were diagnosed.Intervention:Gastric levothyroxine, intravenous dexamethasone and antibiotics were administered.Outcome:Her consciousness was restored and temperature returned to normal 2 days after starting levothyroxine. She was discharged two weeks later.Conclusion:MC is rare but may be the initial presentation in pediatric patients with prolonged untreated hypothyroidism. Autoimmune thyroiditis could cause hypothyroidism in children. MC should be suspected in pediatric patients with altered mental status, hypothermia and cardiovascular instability. Treatment with 100 mg/m2 of gastric levothyroxine is an option for pediatric patients with MC.

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“…Además, se cree que el reemplazo hormonal posterior a tiroidectomía por cáncer inhibiría el crecimiento tumoral en forma indirecta por retroalimentación negativa sobre la secreción de TSH 5 . El riesgo de no tratar a los pacientes con hipotiroidismo es el coma mixedematoso, una emergencia endocrina caracterizada por alteración de conciencia e hipotermia con otros signos clínicos de hipotiroidismo severo 6 , que pone al paciente en riesgo vital de no mediar tratamiento rápido.…”

Section: Servicio Alergología Hospitalunclassified

Desensibilización a levotiroxina. Caso clínico

et al. 2018

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We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. There were no incidents such as urticaria, angioedema, or others. On the second day, the patient received a single-full dose of 112 ug on an empty stomach. The medication was successfully tolerated and she was discharged. Thereafter, she tolerates daily Levothyroxine.

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Myxoedema coma: a forgotten presentation of extreme hypothyroidism

Cited by 7 publications

References 1 publication

Myxedema Coma as Initial Clinical Presentation of Empty Sella Syndrome

Myxedema Coma as Initial Clinical Presentation of Empty Sella Syndrome

Myxedema coma

Desensibilización a levotiroxina. Caso clínico

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