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Myxedema Coma

Myxedema coma is a life-threatening medical emergency caused by severe hypothyroidism. It can occur due to longstanding untreated hypothyroidism or be precipitated by an acute event in patients with poorly controlled hypothyroidism. Symptoms include decreased mental status, hypothermia, and slowing of organ function. Diagnosis is based on history, physical exam, and lab tests showing very high TSH and low T4 levels. Treatment involves intensive care, warming, and high doses of intravenous levothyroxine to rapidly restore thyroid function. Patients must be closely monitored with repeat thyroid function tests to guide ongoing treatment.

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409 views3 pages

Myxedema Coma

Myxedema coma is a life-threatening medical emergency caused by severe hypothyroidism. It can occur due to longstanding untreated hypothyroidism or be precipitated by an acute event in patients with poorly controlled hypothyroidism. Symptoms include decreased mental status, hypothermia, and slowing of organ function. Diagnosis is based on history, physical exam, and lab tests showing very high TSH and low T4 levels. Treatment involves intensive care, warming, and high doses of intravenous levothyroxine to rapidly restore thyroid function. Patients must be closely monitored with repeat thyroid function tests to guide ongoing treatment.

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sam
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Myxedema Coma

o Definition:
Myxedema coma is defined as severe hypothyroidism leading to
decreased mental status, hypothermia, and other symptoms related to
slowing of function in multiple organs. It is a medical emergency with a
high mortality rate.

o Etiology:
1. It can occur as the culmination of severe, longstanding
hypothyroidism or be precipitated by an acute event in a poorly
controlled hypothyroid patient, such as infection, myocardial
infarction, cold exposure, or the administration of sedative
drugs, especially opioids.
2. It can occur in patients who have any of the usual causes of
hypothyroidism, particularly chronic autoimmune thyroiditis.
3. It can occur in patients with central hypothyroidism, and there
are case reports of its occurrence in patients with lithium- or
amiodarone-induced hypothyroidism.

o Clinical Presentation:
o Diagnosis:
The diagnosis of myxedema coma is initially based upon the history,
physical examination, and exclusion of other causes of coma. If the
diagnosis of myxedema coma is suspected, a blood sample should be
drawn prior to treatment for measurement of:
●TSH
●Free thyroxine (T4(
●Cortisol

o Treatment:
o Monitoring:
Serum T4 and T3 should be measured every one to two days to
confirm that the therapy is working and that very high levels of T3 are
avoided. Once there is improvement (regained consciousness,
improved mental status, improved pulmonary and cardiac function),
the patient can be treated with oral T4 alone. The initial oral T4 dose
should be determined based on body weight, age, coexistent
cardiovascular disease, and the recent intravenous dose.

Reference:
Ross.D. (2017) .Myxedema coma. J. E .Mulder (Ed.), UpToDate. Retrieved
February 19, 2018, from [Link]
coma?search=myxedema%20coma&source=search_result&selectedTitle=1~25&
usage_type=default&display_rank=1

Done by Pharm D student : Rola Haider Al Omari


Supervised by Pharm D :Eshraq Al- Abweeny

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