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Research Article| Volume 7, ISSUE 1, P43-56, January 1991

Myxedema Coma

  • Author Footnotes
    * Teaching Fellow
    Lyle Myers
    Correspondence
    Address reprint requests to: LCDR Lyle Myers, MD MC, USNR, Division of Endocrinology-Metabolism, Department of Internal Medicine, National Naval Medical Center, Bethesda, MD 20889-5000
    Footnotes
    * Teaching Fellow
    Affiliations
    From the Division of Endocrinology-Metabolism, Department of Internal Medicine, National Naval Medical Center, and the Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
    Search for articles by this author
  • Author Footnotes
    † Assistant Professor
    James Hays
    Footnotes
    † Assistant Professor
    Affiliations
    From the Division of Endocrinology-Metabolism, Department of Internal Medicine, National Naval Medical Center, and the Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
    Search for articles by this author
  • Author Footnotes
    * Teaching Fellow
    † Assistant Professor
DOI:https://doi.org/10.1016/S0749-0704(18)30322-1
Myxedema Coma
Previous ArticleAdrenal Crisis
Next ArticleThyrotoxicosis in the Critically Ill
      This paper is only available as a PDF. To read, Please Download here.
      Myxedema coma was described during the nineteenth century, but, despite the availability of specific hormonal therapy, the mortality rate remains high. This article discusses the causes, pathophysiology, and clinical presentation of myxedema coma. The differentiation of myxedema coma from the euthyroid sick syndromes is examined. General supportive care as well as specific hormonal replacement therapy is addressed.
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      References

        • Aber C.P.
        • Noble R.L.
        • Thompson G.S.
        • et al.
        Serum lactic dehydrogenase isoenzymes in “myxedema heart disease”.
        Br Heart J. 1966; 28: 663
        • Bagchi N.
        • Brown T.R.
        • Parish R.F.
        Thyroid dysfunction in adults over age 55 years—a study in an urban US community.
        Arch Intern Med. 1990; 150: 785
        • Bagdade J.D.
        Endocrine emergencies.
        Med Clin North Am. 1986; 70: 1111
        • Bermudez F.
        • Surks M.I.
        • Oppenheimer J.H.
        High incidence of decreased serum triiodothyronine concentration in patients with nonthyroidal disease.
        J Clin Endocrinol Metab. 1975; 41: 27
        • Blum M.
        Myxedema coma.
        Am J Med Sci. 1972; 264: 432
        • Brent G.A.
        • Hershman J.M.
        • Braunstein G.D.
        Patients with severe nonthyroidal illness and serum thyrotropin concentrations in the hypothyroid range.
        Am J Med. 1986; 81: 463
        • Burman K.D.
        • Smallridge R.C.
        • Burge J.R.
        • et al.
        Ipodate restores the fasting-induced decrement in thyrotropin secretion.
        J Clin Endocrinol Metab. 1983; 57: 597
        • Burman K.D.
        • Wartofsky L.
        • Dinterman R.E.
        • et al.
        The effect of T3 and reverse T3 administration on muscle protein catabolism during fasting as measured by 3-methylhistidine excretion.
        Metabolism. 1979; 28: 805
        • Crowley W.F.
        • Ridgway E.C.
        • Bough E.W.
        • et al.
        Noninvasive evaluation of cardiac function in hypothyroidism: Response to gradual thyroxine replacement.
        N Engl J Med. 1977; 296: 1
        • Derubertis F.R.
        • Michelis M.F.
        • Bloom M.E.
        • et al.
        Impaired water excretion in myxedema.
        Am J Med. 1971; 51: 41
        • Domm B.M.
        • Vassallo C.L.
        Myxedema coma with respiratory failure.
        Am Rev Respir Dis. 1973; 107: 842
        • Forester C.F.
        Coma in myxedema.
        Arch Intern Med. 1963; 111: 100
        • Goldberg M.
        • Reivich M.
        Studies on the mechanism of hyponatremia and impaired water excretion in myxedema.
        Ann Intern Med. 1962; 56: 120
        • Hickman P.E.
        • Silvester W.
        • Musk A.A.
        • et al.
        Cardiac enzyme changes in myxedema coma.
        Clin Chem. 1987; 33: 622
        • Holvey D.N.
        • Goodner C.J.
        • Nicoloff J.T.
        • et al.
        Treatment of myxedema coma with intravenous thyroxine.
        Arch Intern Med. 1964; 113: 139
        • Ivey H.K.
        Myxedema precoma: Complications and therapy.
        Mayo Clin Proc. 1965; 40: 403
        • Ladenson P.W.
        • Levin A.A.
        • Ridgway E.C.
        • et al.
        Complications of surgery in hypothyroid patients.
        Am J Med. 1984; 77: 261
        • Le Marquand H.S.
        • Hausmann W.
        • Hemsted E.H.
        Myxedema as a cause of death: Report of two cases.
        Br Med J. 1953; 1: 704
        • Massumi R.A.
        • Winnacker J.L.
        Severe depression of the respiratory center in myxedema.
        Am J Med. 1964; 36: 876
        • Mazzaferri E.L.
        Adult hypothyroidism I. Manifestations and clinical presentation.
        Postgrad Med. 1986; 79: 64
        • Mazzaferri E.L.
        Adult hypothyroidism II. Causes, laboratory diagnosis, and treatment.
        Postgrad Med. 1986; 79: 75
        • McCulloch W.
        • Price P.
        • Hinds C.J.
        • et al.
        Effects of low-dose oral triiodothyronine in myxedema coma.
        Intern Care Med. 1985; 11: 259
        • Menendez C.E.
        • Rivlin R.S.
        Thyrotoxic crisis and myxedema coma.
        Med Clin North Am. 1973; 57: 1463
        • Nee P.A.
        • Scane A.C.
        • Lavelle P.H.
        • et al.
        Hypothermic myxedema coma erroneously diagnosed as myocardial infarction because of increased creatinine kinase MB.
        Clin Chem. 1987; 33: 1083
        • Nelson J.C.
        • Weiss R.M.
        The effect of serum dilution on free thyroxine concentration in the low T4 syndrome of nonthyroidal illness.
        J Clin Endocrinol Metab. 1985; 61: 239
        • Nicolloff J.T.
        Thyroid storm and myxedema coma.
        Med Clin North Am. 1985; 69: 1005
        • Rapoport B.
        • Capian R.
        • DeGroot L.J.
        Low-dose sodium iodide 131I therapy in Graves’ disease.
        JAMA. 1973; 224: 1610
        • Reed H.L.
        • Burman K.D.
        • Shakir K.M.M.
        • et al.
        Alterations in the hypothalamic-pituitary-thyroid axis after prolonged residence in Antarctica.
        Clin Endocrinol. 1986; 25: 55
        • Ridgway E.C.
        • McCammon J.A.
        • Benotti J.
        • et al.
        Acute metabolic responses in myxedema to large doses of intravenous L-thyroxine.
        Ann Intern Med. 1972; 77: 549
        • Royce P.C.
        Severely impaired consciousness in myxedema—a review.
        Am J Med Sci. 1971; 261: 46
        • Rush D.R.
        • Hamburger S.C.
        Endocrine metabolic emergencies.
        South Med J. 1984; 77: 220
        • Sanders V.
        Neurologic manifestations of myxedema.
        N Engl J Med. 1962; 266: 547
        • Sanders V.
        Neurologic manifestations of myxedema, concluded.
        N Engl J Med. 1962; 266: 599
        • Schussler G.C.
        Nonthyroidal illness.
        in: Ingbar S.H. Braverman L.E. Werner’s The Thyroid: A Fundamental and Clinical Text. Lippincott, Philadelphia, JB1986: 381
        • Senior R.M.
        • Birge S.J.
        • Wessler S.
        • et al.
        The recognition and management of myxedemacoma.
        JAMA. 1971; 217: 61
        • Sesenbach W.
        • Madison L.
        • Eisenberg S.
        • et al.
        The cerebral circulation and metabolism in hyperthyroidism and myxedema.
        J Clin Invest. 1954; 33: 1434
        • Slag M.F.
        • Morley J.E.
        • Elson M.K.
        • et al.
        Hypothyroxinemia in critically ill patients as a predictor of high mortality.
        JAMA. 1981; 245: 43
        • Spaulding S.W.
        • Chopra I.J.
        • Sherwin R.S.
        • et al.
        Effect of caloric restriction and dietary composition on serum T3 and reverse T3 in man.
        J Clin Endocrinol Metab. 1976; 42: 197
        • Sridama V.
        • McCormick M.
        • Kaplan E.L.
        • et al.
        Long-term follow-up study of compensated low-dose 131I therapy for Graves’ disease.
        N Engl J Med. 1984; 311: 426
        • Steinberg A.D.
        Myxedema and coronary artery disease—a comparative autopsy study.
        Ann Intern Med. 1968; 68: 338
        • Summers V.K.
        Myxedema coma.
        Br Med J. 1953; 2: 366
        • Surks M.I.
        • Hupart E.H.
        • Fan C.
        • et al.
        Normal free thyroxine in critical nonthyroidal illnesses measured by ultrafiltration of undiluted serum and equilibrium dialysis.
        J Clin Endocrinol Metab. 1988; 67: 1031
        • Urbanic R.C.
        • Mazzaferri E.L.
        Thyrotoxic crisis and myxedema coma.
        Heart Lung. 1978; 7: 435
        • Utiger R.D.
        The thyroid: Physiology, hyperthyroidism, hypothyroidism, and the painful thyroid.
        in: Felig P. Baxter J.D. Broadus A.E. Endocrinology and Metabolism. McGraw Hill, New York1987: 389-472
        • Wartofsky L.
        Myxedema coma.
        in: Ingbar S.H. Braverman L.E. Werner’s The Thyroid, a Fundamental and Clinical Text. ed 5. JB Lippincott, Philadelphia1986: 1227
        • Wilson W.R.
        • Bedell G.N.
        The pulmonary abnormalities in myxedema.
        J Clin Invest. 1960; 39: 42
        • Wood L.C.
        • Ingbar S.H.
        Hypothyroidism as a late sequela in patients with Graves’ disease treated with antithyroid agents.
        J Clin Invest. 1979; 64: 1429
        • Zwillich C.W.
        • Pierson D.J.
        • Hofeldt F.D.
        • et al.
        Ventilatory control in myxedema and hypothyroidism.
        N Engl J Med. 1975; 292: 662

      Article info

      Footnotes

      The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Navy Department or the Naval Service at large.

      All material in this article, with the exception of any borrowed tables and figures, is in the public domain.

      Identification

      DOI: https://doi.org/10.1016/S0749-0704(18)30322-1

      Copyright

      © 1991 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

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