Hypothyroidism and Myxedema Coma in Emergency Medicine Medication

  • Author: Erik D Schraga, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 29, 2012
 

Medication Summary

Initiate thyroid hormone replacement as the mainstay therapy for patients with myxedema coma. Patients may remain refractory to other treatment and supportive therapies until thyroid hormone replacement takes effect. Infusing thyroid hormone in the euthyroid patient is unlikely to result in significant morbidity except in patients with ischemic heart disease. Hormonal therapy should be instituted early in patients with a high clinical suspicion of myxedema coma prior to laboratory confirmation.

Monitor the patient's heart during hormone treatment, decreasing or discontinuing the dosage with any evidence of ischemia or dysrhythmia.

The magnitude of hypothyroidism dictates dose and route. Mild cases may be treated with gradual oral replacement, but patients with myxedema coma usually require large doses of IV replacement. General guidelines suggest administration of intravenous levothyroxine at a dose of 500-800 mcg. Alternatively, intravenous liothyronine can be given at a dose of 25 mcg.

Administer antibiotics if infection is suspected to be a precipitating event.

Physicians often recommend glucocorticoid replacement therapy because adrenal insufficiency may be concomitant (especially in patients with secondary hypothyroidism).

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Thyroid products

Class Summary

These agents are used for the replacement of thyroid hormone.

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Liothyronine (Triostat, Cytomel)

 

Synthetic form of natural thyroid hormone (T3) converted from thyroxine (T4); short duration of activity allows quick dose adjustments in event of overdosage.

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Levothyroxine (Synthroid, Levothroid, Levoxyl)

 

Also known as T4; many physicians prefer the more gradual onset of action of this form of thyroid hormone.

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Corticosteroids

Class Summary

These agents are used for prevention and/or treatment of adrenal insufficiency.

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Hydrocortisone (Solu-Cortef)

 

DOC due to mineralocorticoid activity and glucocorticoid effects.

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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

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.

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

Disclosure: Medscape Salary Employment

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.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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