New-Onset Hypothyroidism Manifesting As Myxedema Coma: Fighting an Old Enemy.

Myxedema coma (MC) is a rare manifestation of severe hypothyroidism. This is a true endocrine emergency that may remain unrecognized. We present a case of a 49-year-old man who presented to the emergency department with generalized weakness and confusion. He was found to have low temperature, bradycardia, hypoxia, hypotension, glucose of 59 mg/dL, normal electrolytes, thyroid-stimulating hormone of 154 IU/mL, and free T4 of 0.1 ng/dL. His anti-peroxidase antibody level was 99 IU/mL. Echocardiography revealed a normal ejection fraction and no evidence of pericardial effusion. On the basis of his presentation and laboratory findings, he was diagnosed with MC, intubated, and admitted to the intensive care unit. Thyroid hormone replacement and glucocorticoid treatment were initiated immediately. After the clinical improvement, the patient was extubated. MC is associated with a high mortality rate and requires prompt recognition and treatment. This rare case reminds us that MC might still be the first manifestation of primary hypothyroidism, although considered an "old enemy".

A survey of radiology chairpersons' perceptions of the relative importance of education of medical students, residents, and fellows.

OBJECTIVE: The purpose of the study was twofold: to assess radiology chairpersons' perceptions about the value of education of medical students, residents, and fellows with respect to the achievement of department success and to uncover their personal involvement in instructional activities. MATERIALS AND METHODS: A questionnaire was sent to all American members of the Society of Chairmen in Academic Radiology (SCARD) requesting their opinions about 21 putative responsibilities of their job including student, resident, and fellow education. The survey also asked the respondents to list the size of their trainee complement, both residents and fellows. The data were assessed in toto and after disaggregation by program size as indicated by the number of trainees and by the percentage of fellows versus all trainees. RESULTS: Sixty-nine of 108 chairpersons responded with contributory responses for a response rate of 63.9%. Resident training was the fourth most frequently affirmatively cited component of their perceptions of a department's success at 86% positive. Slightly more than half indicated that they were personally involved in resident instruction but less than a third participated in student or in fellow training. Disaggregation by the size of the department with respect to the number of trainees revealed that resident teaching as a critical factor decreased in estimation of importance from 100% to 64% (p < 0.001) as programs increased in size. Fellowship training correspondingly increased from 18% to 45% (p = 0.054) from small to large departments. CONCLUSION: Resident education as a valued activity and as a specific chair function varies inversely with both program size and the percentage of fellows among all trainees.