Myxedema Coma
Very rarely do we see patients presenting with the symptoms of myxedema coma. This is a life threatening condition that is caused by a deficiency in the thyroid gland causing hypothyroidism. First, let's take a look at hypothyroidism to see what symptoms lead to a patient being in a myxedema coma.
Symptoms Of Hypothyroidism
The thyroid gland is responsible mainly for regulating a person's metabolism and use of energy including breathing, heart rate, body weight, menstrual cycles, body temperature, and more. Having too much or too little thyroid hormone can cause major disturbances to a person's metabolism and organ function. According to the Mayo Clinic, symptoms of hypothyroidism are as follows:
Fatigue
Increased sensitivity to cold
Constipation
Dry skin
Weight gain
Puffy face
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
How Does Hypothyroidism Develop Into A Myxedema Coma?
A myxedema coma can result when thyroid hormone levels are dangerously low. This can happen quickly or over a series of months. The main causes (in association with hypothyroidism) are as follows:
Infections, especially lung and urine infections
Trauma
Surgery
Drugs, such as phenothiazines, amiodarone, lithium, and tranquilizers, and prolonged iodide use
Not taking prescribed thyroid medications
Treatment
One patient I cared for in the ICU had a mixture of clinical symptoms which we treated. The patient was extremely lethargic, had a very swollen face/neck, low body temperature, low blood pressure, and very abnormal thyroid hormone levels. We consulted endocrinology and there were a variety of interventions that we had to perform. We gave a very large loading dose of levothyroxine, maintenance doses of levothyroxine, and doses of iodothyronine. These help to reestablish normal levels of thyroid hormones and body metabolism. The patient was hypothermic at 93.1 degrees so we warmed him using a bair hugger blanket (essentially a blanket inflated with warm air). We gave hydrocortisone to boost his cortisol levels. We monitored his electrolytes very closely, and he received multiple doses of potassium, magnesium, calcium, and potassium phosphate. The patient's blood pressure was low so he received multiple fluid boluses and was eventually started on vasopressors for blood pressure support. This type of patient needs very close attention to vital signs and lab results. If not treated quickly enough, patients can die from this condition.
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