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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thyroid storm is a rapid decompensation of severe hyperthyroidism which can best be described by the three criteria of hyperthermia, tachycardia and altered mental state with severe agitation. There has to be a precipitating factor such as infection, iodine contamination, surgery or even I-131 treatment. Severe hyperthyroidism not fulfilling the criteria of thyroid storm can also be an indication for emergency treatment, particularly in the elderly with heart disease. Suppressed serum TSH and elevated free T4 levels are essential to confirm the diagnosis. When rapidly available, radioiodine uptake of the thyroid can be useful. Therapy aims at rapidly reducing the active circulating hormone pool, hypermetabolic state, tachycardia, and finally hormone synthesis. Thyroid secretion can be blocked by ioipanoic acid or ipodate while hypermetabolic state can be reduced with beta-blockers or calcium channel-blockers. Treatment of hyperthyroidism in patients with iodine contamination is a real therapeutic challenge. Myxoedema coma, a complication of severe hypothyroidism, is defined by hypothermia (rectal temperature less than 36 degrees C), bradycardia, slow mentation, precipitating factor such as infection or drug overdose, and increased serum creatine phosphokinase levels. Diagnosis of severe hypothyroidism should be confirmed by serum measurements of TSH and free T4. Treatment consists of general supporting measures including rewarming, correction of serum electrolyte disturbances, and adequate alimentation. Thyroid hormone treatment should initially be aggressive using either 300-400 micrograms of T4 or 20-40 micrograms of T3 intravenously. Cortisone therapy may be added. Patients should be under close monitoring as arrhythmias and myocardial infarction are frequent complications of myxoedema coma and/or its treatment with thyroid hormones.
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PMID:Thyroid emergencies. 173 98

Myxedema coma, an extreme expression of hypothyroidism, represents a medical emergency with high mortality. Hypothermia and cerebro-vascular accidents should be taken into account for correct differential diagnosis. The treatment of myxedema coma is based on prevention of the precipitating factors and on the administration of generous doses of L-thyroxine and/or triiodothyronine, associated with steroids and drugs for respiratory and cardio-vascular complications.
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PMID:[Myxedema coma]. 220 66

Myxedema coma is the most severe form of hypothyroidism and is characterized by extreme hypothermia, bradycardia, central hypoventilation and hypoxia. Common causes are intercurrent diseases, interruption of thyroid hormone treatment, or an overdose of sleeping pills or sedatives. The diagnosis is usually readily established on the basis of very high serum TSH and low T4 levels. Consideration must also be given to an extra-thyroidal influence on the hormone levels. Intensive care treatment involving intravenous high-dose L-thyroxine and the reversal of hypoxia improve the prognosis of the serious disease.
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PMID:[Coma in myxedema--a rare complication of hypothyroidism. Possible iatrogenic factors should be taken into account]. 908 99

A 7-year-old male English Coonhound with suspected myxedema coma complicated by severe hypothermia and metabolic abnormalities was treated with a combination of active external and core rewarming techniques, i.v. and oral administration of levothyroxine, supplemental oxygen, and administration of fluids (0.9% NaCl solution). Myxedema coma develops as a consequence of severe hypothyroidism and is characterized by a hypometabolic, stuporous state. Myxedema coma is associated with a high mortality rate, and most reported cases have involved Doberman Pinschers. Intravenous administration of levothyroxine can be used successfully in combination with oral administration to restore normal metabolic function and assist in warming and thermoregulation, although dosages should be conservative to avoid adverse cardiovascular effects.
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PMID:Intravenous administration of levothyroxine for treatment of suspected myxedema coma complicated by severe hypothermia in a dog. 1070 87

Myxedema coma is a rare and life-threatening complication of untreated hypothyroidism. Therefore, it must be part of the differential diagnosis in comatose patients. We report one patient who presented with CO(2) narcosis,hypothermia, bradycardia,hyporeflexia, tetraparesis, ascitis, pleural effusions, and heart insufficiency. Examination of the CSF, cranial CT, MRI, and MR angiography were normal. In suspicion of myxedema coma,the patient was treated with high dose L-thyroxine and hydrocortisone for preventing secondary adrenal insufficiency. A fast clinical recovery, decreased T4 (7.2 ng/l) and T3 (0.93 ng/l), and increased TSH (20.19 mU/l) together with the following anamnesis of radio iodine therapy and insufficient thyroxine intake confirmed the diagnosis. In conclusion, treatment of the myxedema coma must be started as soon as the laboratory results are confirmatory, since its course depends on the time of initiation of treatment.
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PMID:[Myxedema coma as a rare differential diagnosis of severe consciousness disturbance]. 1248 69

A 10-year-old, intact male, cocker spaniel was presented with hypothermia, without shivering, and progressive stupor leading to coma. Myxedema coma, potentially precipitated by diuretic therapy, was tentatively diagnosed and treatment initiated, but progressive respiratory depression led to the decision to euthanize. Postmortem findings supported the diagnosis of myxedema coma.
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PMID:Myxedema coma leading to respiratory depression in a dog. 1514 5

Myxedema coma is the term given to the most severe presentation of profound hypothyroidism and is often fatal in spite of therapy. Decompensation of the hypothyroid patient into a coma may be precipitated by a number of drugs, systemic illnesses (eg, pneumonia), and other causes. It typically presents in older women in the winter months and is associated with signs of hypothyroidism, hypothermia, hyponatremia, hypercarbia, and hypoxemia. Treatment must be initiated promptly in an intensive care unit setting. Although thyroid hormone therapy is critical to survival, it remains uncertain whether it should be administered as thyroxine, triiodothyronine, or both. Adjunctive measures, such as ventilation, warming, fluids, antibiotics, pressors, and corticosteroids, may be essential for survival.
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PMID:Myxedema coma. 1712 41

Myxoedema coma is a rare and life-threatening illness the outcome of which has not been robustly studied in large numbers, partly due to its low incidence. Dutta and colleagues have explored outcome predictors in a developing country where access to thyroid function tests is more limited than in the Western world. Cardiovascular instability, reduced consciousness, persistent hypothermia, and sepsis all contributed to a poorer outcome, as has been demonstrated before, but a generic outcome predictor model was shown to be useful in this group of patients. Unfortunately, this observational study was unable to show differences in outcome based on replacement treatment methods and the mortality remains at 40%.
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PMID:Predictors of outcome in myxoedema coma. 1817 46

The thyroid hormones are synthesized by iodine. Thyroid dysfunction can develop in patients who have received treatment with iodine-containing contrast media or treatment with amiodarone. Thyrotoxicosis is a symptom due to high levels of thyroid hormone. The entity most threatened is the cardiovascular system. beta-adrenergic receptor blockade can control the heart rate. And a decreasing heart rate may improve heart-pumping function. We should aim to avoid surgery on any patients whose thyroid function is abnormal. The avoidance of a thyroid storm is the goal in managing hyperthyroid patients. Suppression of the sympathetic tone and maintenance of a deep level of surgical anesthesia are prudent. Thyroid storm is rare nowadays but still carries a high mortality. Precipitating factors include infection, surgery, childbirth or trauma, et al. Hypothyroid patients are sensitive to the effects of anesthetic agents and many drugs, including opioids. Mild hypothyroidism may have little perioperative significance. However, overt hypothyroidism can develop in a high percentage of patients with history of subclinical hypothyroidism. An untreated patient with hypothyroidism may present as an emergency with myxedema coma. Myxedema coma is rare but carries a high mortality. Precipitating factors include hypothermia, surgery, trauma, sedative drugs, et al.
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PMID:[Abnormality of thyroid function]. 2066 90

Myxedema coma is the extreme form of untreated hypothyroidism. In reality, few patients present comatose with severe myxedema. We describe a patient with myxedema coma which was initially misdiagnosed as a brain stem infarct. She presented to the hospital with alteration of the mental status, generalized edema, hypothermia, hypoventilation, and hypotension. Initially her brain stem reflexes were absent. After respiratory and circulatory support, her neurologic status was not improved soon. The diagnosis of myxedema coma was often missed or delayed due to various clinical findings and concomitant medical condition and precipitating factors. It is more difficult to diagnose when a patient has no medical history of hypothyroidism. A high index of clinical suspicion can make a timely diagnosis and initiate appropriate treatment. We report this case to alert clinicians considering diagnosis of myxedema coma in patients with severe decompensated metabolic state including mental change.
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PMID:A case of myxedema coma presenting as a brain stem infarct in a 74-year-old Korean woman. 2080 90


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