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Myxedema Coma or Crisis Workup

  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
 
Updated: Dec 15, 2015
 

Laboratory Studies

Laboratory studies are important to confirm the diagnosis of myxedema coma. However, if the condition is suspected, treatment should be started immediately without waiting for the results.

  • Thyroid function tests
    • TSH is elevated in most patients indicating a primary thyroid disorder
    • Free T4 and free T3 levels are low
    • A low or normal TSH level with low levels of free T4 and free T3 may indicate that the disorder is due to pituitary or hypothalamic dysfunction  
  • Assessment of adrenal function should be performed. A random serum cortisol can be obtained; however, the test is only helpful if it’s very low (<3 mcg/dL) or high (>20 mcg/dL). Since most patients will have serum cortisol levels in between these values, an ACTH stimulation test is usually needed to assess the adrenal function. This test should not delay starting treatment. In contrast to hydrocortisone, which interferes with the cortisol assay, leading to falsely normal serum cortisol, dexamethasone does not interfere with the testing and can be administered immediately and continued until the results of the test become available.
  • Hyponatremia with low serum osmolality
  • Because of decreased renal perfusion, serum creatinine levels are usually elevated
  • Hypoglycemia is common and may also be caused by reduced nutrition, sepsis, or the associated adrenal insufficiency.
  • Complete blood count: leukocytosis may not be seen because of hypothermia. A white blood cell differential may be one of the few clues to the presence of infection.

A diagnostic scoring system for the diagnosis of myxedema coma has been proposed.[25] The scoring system gives points for the following indicators: hypothermia; lethargy, obtundation, stupor, or coma; anorexia, reduced intestinal mobility, or paralytic ileus; bradycardia, electrocardiogram changes, pericardial or pleural effusions, cardiomegaly or hypertension; hyponatremia, hypoglycemia, hypoxemia, hypercapnia or reduced glomerular filtration rate, and the presence of a precipitating cause. This scoring system was based on data derived from a small sample of 21 patients, which may limit its generalizability.

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Imaging Studies

Chest X-ray may show signs of cardiomegaly, pericardial effusion, congestive heart failure, or pleural effusion.

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Other Tests

Electrocardiogram may reveal sinus bradycardia, low-amplitude QRS complexes, a prolonged QT interval, flattened or inverted T waves, or arrhythmias.

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Contributor Information and Disclosures
Author

Mohsen S Eledrisi, MD, FACP, FACE Senior Consultant, Department of Medicine/Endocrinology, Hamad Medical Corporation, Qatar

Mohsen S Eledrisi, MD, FACP, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Stephanie L Lee, MD, PhD Associate Professor, Department of Medicine, Boston University School of Medicine; Director of Thyroid Health Center, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Fellow, Association of Clinical Endocrinology

Stephanie L Lee, MD, PhD is a member of the following medical societies: American College of Endocrinology, American Thyroid Association, Endocrine Society

Disclosure: Nothing to disclose.

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