Hypothyroidism and Myxedema Coma Follow-up

Updated: May 11, 2017
  • Author: Erik D Schraga, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Follow-up

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 [9]
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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%. [10]

The aforementioned study by Ono et al reported that, as revealed through multivariable logistic regression, a higher inhospital mortality rate in myxedema coma was associated with older age and catecholamine use (with or without steroids). [4]

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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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