Myxedema coma
| Myxedema coma | |
|---|---|
| Classification and external resources | |
| Specialty | endocrinology |
| ICD-10 | E03.5 |
Myxedema coma is a state of decompensated hypothyroidism. A person may have lab values identical to a "normal" hypothyroid state, but a stressful event (such as an infection, myocardial infarction or stroke) precipitates the myxedema coma state, usually in the elderly. Primary symptoms of myxedema coma are altered mental status and low body temperature. Low blood sugar, low blood pressure, hyponatremia, hypercapnia, hypoxia, slowed heart rate, and hypoventilation may also occur. Myxedema, although included in the name, is not necessarily seen in myxedema coma.
Treatment
Mechanical ventilation if there is significant hypoxia.
Intravenous high doses of T4, T4 and T3, or T3. IV Levothyroxine (500-800 µg). However, liothyronine is preferred due to its rapid onset of action.
Determine initial cortisol level, and administer corticosteroids (hydrocortisone at 5-10 mg/h).
Gradual warming with blankets; an external heating source should not be used.
Consider starting antibiotic prophylaxis until cultures come back, since infection is often the precipitating cause.[1]