Hypothyroidism & Myxedema Coma

Chapter 216 Tintinalli

Hypothyroidism & Myxedema Coma

Hypothyroidism: Diminished production of thyroid hormone, leading to clinical manifestations of thyroid insufficiency, including low metabolic rate, tendency to weight gain, somnolence and sometimes myxedema.

Steadmans Dictionary

Hypothyroidism & Myxedema Coma

Etiologies of Hypothyroidism

Primary

Autoimmune Idiopathic Post Surgical or Radioiodine Ablation External Radiation Iodine Deficiency Congenital Lymphoma, Sarcoid, Amyloidosis, Tb

Hypothyroidism & Myxedema Coma

Etiologies of Hypothyroidism

Secondary

Panhypopituitarism {Pituitary} Neoplasms Infiltrative

Tertiary

Drugs:

Amiodarone, Lithium, Iodine

Hypothyroidism & Myxedema Coma

Signs & Symptoms of Hypothyroidism

Fatigue, Weight Gain, Cold Intolerance, Depression, Menstrual Irregularities, Joint Pains, Muscle Cramps, Infertility.
Hoarseness, Hypothermia, Periorbital Puffiness, Delayed Relaxation of Ankle Jerk, Cool/Rough/ Dry Skin, Non-pitting Edema, Bradycardia Peripheral Neuropathy.

Hypothyroidism & Myxedema Coma

Lab Tests:

TSH Thyroid Stimulating Hormone T4 Free T4 is used to assess Thyroid Fctn

**Because of the prevelance of Hypothyroidism in females > 60y/o, a serum TSH routinely (per year) should be obtained.

Hypothyroidism & Myxedema Coma

Hypothyroidism Treatment:

Thyroxine 50 100micrograms/ day initially Thyroxine 75 150 micrograms/ day average

Hypothyroidism & Myxedema Coma

Myxedema Coma: Hypothyroidism with a relatively

hard edema of subcutaneous tissue, with increased content of mucins in the fluid; somnolence, slow mentation, dryness and loss of hair, increased fluid in body cavities such as the pericardial sac, subnormal temperature, hoarseness, muscle weakness, and slow return of a muscle to the neutral position after a tendon jerk; usually caused by removal or loss of functioning thyroid tissue.

Steadmans Dictionary

Hypothyroidism & Myxedema Coma

Myxedema Coma

A rare clinical state of insidious onset, in an individual with pre-existing hypothyroidism. This represents a life threatening decompensation of the patients condition.

Hypothyroidism & Myxedema Coma

Myxedema Coma Findings:

Decrease mental status from baseline Hypothermia/ Hypoglycemia/ Hyponatremia Bradycardia Hypoventillation Peri-orbital edema Non-pitting Edema Delayed Tendon Reflexes

Hypothyroidism & Myxedema Coma

Findings are not just a decline in metabolic function but are also from a decline in cardiac and neurovascular adaptations. There exists a change in end- organ responsiveness to catecholamines and cardiac performance. ** Clinical suspicion is paramount ***History of Medication changes???

Hypothyroidism & Myxedema Coma

Myxedema Coma Treatment:

#1 Recognition! ABCs Thyroid replacement w/ Levothyroxine 300 500 micrograms slow IV then maintenance. Glucocorticoid Hydrocortisone100mgIVq8*

For Prevention of Adrenal Crisis

Temp/ Electrolyte/ Glucose Management

Hypothyroidism & Myxedema Coma

QUIZ:

1. Most effecatious lab test for Hypothyoid?

A. CBC B. TSH C. T-4 D. T-3 Free

2. T/F Myxedema Coma is life-threatening? 3. T/F Initial Dose of Thyroxine is 50 100mg?

4. The Dose of Thyroxine for Myxedema is______?

Hypothyroidism & Myxedema Coma

Hypothyroidism & Myxedema Coma