Hypothyroidism and Myxedema Coma Follow-up

  • Author: Erik D Schraga, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
 
Updated: Dec 11, 2015
 

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.
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Complications

Potential complications are as follows:

  • Treatment-induced congestive heart failure in patients with coronary artery disease
  • Myxedema coma
  • Increased susceptibility to infection
  • Megacolon
  • Organic psychosis with paranoia
  • Adrenal crisis with vigorous treatment of hypothyroidism
  • Hypersensitivity to opiates
  • Pericardial effusion and cardiac tamponade[8]
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Prognosis

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%.[9]

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Patient Education

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

For patient education resources, see the Endocrine System Center, as well as Thyroid Problems and Myxedema Coma.

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Contributor Information and Disclosures
Author

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

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.

Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

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.

Acknowledgements

Jerome FX Naradzay, MD, FACEP Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
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  2. Dubbs SB, Spangler R. Hypothyroidism: causes, killers, and life-saving treatments. Emerg Med Clin North Am. 2014 May. 32 (2):303-17. [Medline].

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  15. 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].

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  19. Smith SA. Commonly asked questions about thyroid function. Mayo Clin Proc. 1995 Jun. 70(6):573-7. [Medline].

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Pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette.
 
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