Hypothyroidism and Myxedema Coma Follow-up
- Author: Erik D Schraga, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more...
Further Inpatient Care
Further inpatient care is as follows:
- Admit patients with myxedema coma to ICU.
- Provide supportive ventilatory and hemodynamic management.
- Treat precipitating events (eg, infection).
- Continue rewarming as required.
- Confirm diagnosis with laboratory testing.
- Continue thyroid hormone replacement, and convert to oral therapy when tolerated.
- Clinical improvement should be apparent within 24-36 hours of initiating thyroid hormone replacement.
Potential complications are as follows:
- Treatment-induced congestive heart failure in patients with coronary artery disease
- Myxedema coma
- Increased susceptibility to infection
- Organic psychosis with paranoia
- Adrenal crisis with vigorous treatment of hypothyroidism
- Hypersensitivity to opiates
- Pericardial effusion and cardiac tamponade
The prognosis of hypothyroidism is good with early treatment. However, once the disease has progressed to myxedema coma, the mortality rate may exceed 20% in the treated population. Relapses occur if treatment is discontinued.
The mortality rate in myxedema coma has historically been as high as 80%. Some data suggest that aggressive management and early recognition have improved the mortality rate to 15-20%. However, a more recent observational study was unable to show significant differences in outcome based on replacement therapeutic methods, with a mortality rate remaining high at 40%.
Patients should be educated about the following:
- Importance of medication compliance
- Need for lifelong treatment
- Watch for signs of infection
- Watch for signs of thyrotoxicity
Dubbs SB, Spangler R. Hypothyroidism: causes, killers, and life-saving treatments. Emerg Med Clin North Am. 2014 May. 32 (2):303-17. [Medline].
[Guideline] Screening for congenital hypothyroidism: US Preventive Services Task Force reaffirmation recommendation. Ann Fam Med. 2008 Mar-Apr. 6(2):166. [Medline].
Teng W, Shan Z, Teng X, Guan H, et. al. Effect of iodine intake on thyroid diseases in China. N Eng J Med. Jun 2006. 354(26):2783-2793. [Medline].
Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, et al. A diagnostic scoring system for myxedema coma. Endocr Pract. 2014 Aug. 20 (8):808-17. [Medline].
Lee CH, Wira CR. Severe angioedema in myxedema coma: a difficult airway in a rare endocrine emergency. Am J Emerg Med. 2009 Oct. 27(8):1021.e1-2. [Medline].
Sanda S, Newfield RS. A child with pericardial effusion and cardiac tamponade due to previously unrecognized hypothyroidism. J Natl Med Assoc. Dec 2007. 99(12):1411-3. [Medline].
Ragland G. Hypothyroidism and myxedema coma. Tintinalli JE, Krome RL, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 4th ed. New York, NY: McGraw-Hill; 1996. 964-67.
Unuane D, Tournaye H, Velkeniers B, Poppe K. Endocrine disorders & female infertility. Best Pract Res Clin Endocrinol Metab. 2011 Dec. 25(6):861-73. [Medline].
Flynn RW, MacDonald TM, Morris AD. The thyroid epidemiology, audit, and research study: thyroid dysfunction in the general population. J Clin Endocrinol Metab. 2004 Aug. 89(8):3879-84. [Medline].
Franklyn JA. The management of hyperthyroidism. N Engl J Med. 1994 Jun 16. 330(24):1731-8. [Medline].
Hehrmann R. [Coma in myxedema--a rare complication of hypothyroidism. Possible iatrogenic factors should be taken into account]. Fortschr Med. 1996 Dec 10. 114(34):474-8. [Medline].
Kinuya S, Michigishi T, Tonami N, et al. Reversible cerebral hypoperfusion observed with Tc-99m HMPAO SPECT in reversible dementia caused by hypothyroidism. Clin Nucl Med. 1999 Sep. 24(9):666-8. [Medline].
Menendez CE, Rivlin RS. Thyrotoxic crisis and myxedema coma. Med Clin North Am. 1973 Nov. (6):1463-70. [Medline].
Rimar D, Kruzel-Davila E, Dori G, Baron E, Bitterman H. Hyperammonemic coma--barking up the wrong tree. J Gen Intern Med. Apr 2007. 22(4):549-52. [Medline].
Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004 Mar 6. 363(9411):793-803. [Medline].
Smith SA. Commonly asked questions about thyroid function. Mayo Clin Proc. 1995 Jun. 70(6):573-7. [Medline].