Myxedema Coma

Merve UNUTMAZa , Mehmet Emin UNUTMAZb

aAnkara Bilkent City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye
bAnkara Bilkent City Hospital, Clinic of Surgical Oncology, Ankara, Türkiye

ABSTRACT
Myxedema coma is a rare but severe complication of hypothyroidism, characterized by high mortality rates. Advances in thyroid-stimulating hormone (TSH) tests have reduced its occurrence by enabling early hypothyroidism diagnosis. Typically affecting elderly individuals and women, it can be triggered by factors like prolonged hypothyroidism, infections, and myocardial infarction. Clinical manifestations include mental status impairment, hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia, and generalized edema. Diagnosis involves clinical history, physical examination, and exclusion of other causes. Treatment should be started immediately in the presence of clinical suspicion. Treatment includes intravenous thyroid hormones, glucocorticoids, and supportive measures. While early intervention improves the prognosis, advanced age, cardiac comorbidities and complications are factors that increase mortality.
Keywords: Myxedema; coma; myxedema coma; hypothyroidism; complication

Referanslar

  1. Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med. 2007;22(4):224-31. [Crossref]  [PubMed]
  2. Ylli D, Klubo-Gwiezdzinska J, Wartofsky L. Thyroid emergencies. Pol Arch Intern Med. 2019;129(7-8):526-34. Erratum in: Pol Arch Intern Med. 2019;129(9):653. [Crossref]  [PubMed]  [PMC]
  3. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-751. [Crossref]  [PubMed]  [PMC]
  4. Wilson SA, Stem LA, Bruehlman RD. Hypothyroidism: Diagnosis and Treatment. Am Fam Physician. 2021;103(10):605-613.
  5. Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. J Epidemiol. 2017;27(3):117-22. [Crossref]  [PubMed]  [PMC]
  6. Yafit D, Carmel-Neiderman NN, Levy N, Abergel A, Niv A, Yanko-Arzi R, et al. Postoperative myxedema coma in patients undergoing major surgery: Case series. Auris Nasus Larynx. 2019;46(4):605-8. [Crossref]  [PubMed]
  7. Mir SA, Wani AI, Masoodi SR, Bashir MI, Ahmad N. Lithium toxicity and myxedema crisis in an elderly patient. Indian J Endocrinol Metab. 2013;17(Suppl 3):S654-6. [Crossref]  [PubMed]  [PMC]
  8. Kao PH. Oral Levothyroxine Treatment in Lithium Intoxication- Induced Myxedema Coma: A Case Report. J Acute Med. 2021;11(2):68-71.
  9. Gummalla S, Manjunath M, Phillips B. Myxedema Coma: A Life-Threatening Condition in Patients Using Pembrolizumab. Case Rep Endocrinol. 2020;2020:8855943. [Crossref]  [PubMed]  [PMC]
  10. Hawatmeh A, Thawabi M, Abuarqoub A, Shamoon F. Amiodarone induced myxedema coma: Two case reports and literature review. Heart Lung. 2018;47(4):429-431. [Crossref]  [PubMed]
  11. Westphal SA. Unusual presentations of hypothyroidism. Am J Med Sci. 1997;314(5):333-7. [Crossref]  [PubMed]
  12. Mavroson MM, Patel N, Akker E. Myxedema Psychosis in a Patient With Undiagnosed Hashimoto Thyroiditis. J Am Osteopath Assoc. 2017;117(1):50-4. [Crossref]  [PubMed]
  13. Jansen HJ, Doebé SR, Louwerse ES, van der Linden JC, Netten PM. Status epilepticus caused by a myxoedema coma. Neth J Med. 2006; 64(6):202-5.
  14. Fjølner J, Søndergaard E, Kampmann U, Nielsen S. Complete recovery after severe myxoedema coma complicated by status epilepticus. BMJ Case Rep. 2015;2015:bcr2014209071. [Crossref]  [PubMed]  [PMC]
  15. Cruz-Flores S. Neurological Complications of Endocrine Emergencies. Curr Neurol Neurosci Rep. 2021;21(5):21. [Crossref]  [PubMed]
  16. Maharjan G, Yadav MK, Khati N, Yadav SK, Shrestha TR. Hypothyroidism Induced Hyponatremia: A Case Report. JNMA J Nepal Med Assoc. 2022;60(253):815-6. [Crossref]  [PubMed]  [PMC]
  17. Woehrle T, Lichtenauer U, Bayer A, Brunner S, Angstwurm M, Schäfer ST, et al. Misleading symptoms and successful noninvasive rewarming of a patient with severe hypothermia (23.1 °C). Anaesthesist. 2018;67(12):931-5. English. [Crossref]  [PubMed]
  18. Sun J, Peng Q, Huaguo Y, Hu L, Zhou H. Severe hypoxemia after extubation secondary to myxedema coma: a case report. J Int Med Res. 2023;51(9):3000605231197947. [Crossref]  [PubMed]  [PMC]
  19. Jones BN, Kumar B, Pfirman K. Life-Threatening Cardiac Arrhythmias in a Case of Undetected Myxedema Coma: Importance of Early Detection and Medication Adherence. Am J Case Rep. 2023;24:e941414. [Crossref]  [PubMed]  [PMC]
  20. Vazquez-Fuster JI, Rivera G, Vicenty-Rivera SI, Merced F. Myxedema Coma and the Heart: Would You Miss the Signs? Cureus. 2023;15(9):e45164. [Crossref]
  21. Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, et al. A diagnostic scoring system for myxedema coma. Endocr Pract. 2014;20(8):808-17. [Crossref]  [PubMed]
  22. Chaudhary S, Das L, Sharma N, Sachdeva N, Bhansali A, Dutta P. Utility of myxedema score as a predictor of mortality in myxedema coma. J Endocrinol Invest. 2023;46(1):59-65. [Crossref]  [PubMed]
  23. Wartofsky L. Myxedema coma. In: Braverman LE, Utiger RD, eds. The Thyroid: A Fundamental and Clinical Text. Philadelphia: Lippincott, Williams & Wilkins; 2000. p. 843.
  24. Mitchell-Brown F, Gates C. Myxedema coma: Recognition and treatment. Nursing. 2022;52(7):17-21. [Crossref]  [PubMed]
  25. Yamamoto T, Fukuyama J, Fujiyoshi A. Factors associated with mortality of myxedema coma: report of eight cases and literature survey. Thyroid. 1999;9(12):1167-74. [Crossref]  [PubMed]
  26. Rodríguez I, Fluiters E, Pérez-Méndez LF, Luna R, Páramo C, García-Mayor RV. Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution. J Endocrinol. 2004;180(2):347-50. [Crossref]  [PubMed]
  27. Ueda K, Kiyota A, Tsuchida M, Okazaki M, Ozaki N. Successful treatment of myxedema coma with a combination of levothyroxine and liothyronine. Endocr J. 2019;66(5):469-74. [Crossref]  [PubMed]
  28. Gadaen RJ, Tummers-de Lind van Wijngaarden RF. Hypothyroid Crisis: Oral or Intravenous Treatment? A Report of Two Cases. Eur J Case Rep Intern Med. 2021;8(9):002752. [Crossref]  [PubMed]  [PMC]
  29. Spitzweg C, Reincke M, Gärtner R. Schilddrüsennotfälle : Thyreotoxische Krise und Myxödemkoma [Thyroid emergencies : Thyroid storm and myxedema coma]. Internist (Berl). 2017;58(10):1011-9. German. [Crossref]  [PubMed]
  30. Beynon J, Akhtar S, Kearney T. Predictors of outcome in myxoedema coma. Crit Care. 2008;12(1):111. [Crossref]  [PubMed]  [PMC]
  31. Bourcier S, Coutrot M, Ferré A, Van Grunderbeeck N, Charpentier J, Hraiech S, et al. Critically ill severe hypothyroidism: a retrospective multicenter cohort study. Ann Intensive Care. 2023;13(1):15. [Crossref]  [PubMed]  [PMC]