[Thyroid emergencies : Thyroid storm and myxedema coma]. / Schilddrüsennotfälle : Thyreotoxische Krise und Myxödemkoma.

Thyroid emergencies are rare life-threatening endocrine conditions resulting from either decompensated thyrotoxicosis (thyroid storm) or severe thyroid hormone deficiency (myxedema coma). Both conditions develop out of a long-standing undiagnosed or untreated hyper- or hypothyroidism, respectively, precipitated by an acute stress-associated event, such as infection, trauma, or surgery. Cardinal features of thyroid storm are myasthenia, cardiovascular symptoms, in particular tachycardia, as well as hyperthermia and central nervous system dysfunction. The diagnosis is made based on clinical criteria only as thyroid hormone measurements do not differentiate between thyroid storm and uncomplicated hyperthyroidism. In addition to critical care measures therapy focusses on inhibition of thyroid hormone synthesis and secretion (antithyroid drugs, perchlorate, Lugol's solution, cholestyramine, thyroidectomy) as well as inhibition of thyroid hormone effects in the periphery (ß-blocker, glucocorticoids).Cardinal symptoms of myxedema coma are hypothermia, decreased mental status, and hypoventilation with risk of pneumonia and hyponatremia. The diagnosis is also purely based on clinical criteria as measurements of thyroid hormone levels do not differ between uncomplicated severe hypothyroidism and myxedema coma. In addition to substitution of thyroid hormones and glucocorticoids, therapy focusses on critical care measures to treat hypoventilation and hypercapnia, correction of hyponatremia and hypothermia.Survival of both thyroid emergencies can only be optimized by early diagnosis based on clinical criteria and prompt initiation of multimodal therapy including supportive measures and treatment of the precipitating event.

Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan.

BACKGROUND: Myxedema coma is a life-threatening and emergency presentation of hypothyroidism. However, the clinical features and outcomes of this condition have been poorly defined because of its rarity. METHODS: We conducted a retrospective observational study of patients diagnosed with myxedema coma from July 2010 through March 2013 using a national inpatient database in Japan. We investigated characteristics, comorbidities, treatments, and in-hospital mortality of patients with myxedema coma. RESULTS: We identified 149 patients diagnosed with myxedema coma out of approximately 19 million inpatients in the database. The mean (standard deviation) age was 77 (12) years, and two-thirds of the patients were female. The overall proportion of in-hospital mortality among cases was 29.5%. The number of patients was highest in the winter season. Patients treated with steroids, catecholamines, or mechanical ventilation showed higher in-hospital mortality than those without. Variations in type and dosage of thyroid hormone replacement were not associated with in-hospital mortality. The most common comorbidity was cardiovascular diseases (40.3%). The estimated incidence of myxedema coma was 1.08 per million people per year in Japan. Multivariable logistic regression analysis revealed that higher age and use of catecholamines (with or without steroids) were significantly associated with higher in-hospital mortality. CONCLUSIONS: The present study identified the clinical characteristics and outcomes of patients with myxedema coma using a large-scale database. Myxedema coma mortality was independently associated with age and severe conditions requiring treatment with catecholamines.

Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution.

This study was carried out to investigate the clinical and biochemical factors which might be of importance in predicting the outcome of patients with myxoedema coma. Eleven patients (ten female) aged 68.1+/-19.5 years attended our institution over a period of 18 years. Glasgow and APACHE II scores and serum free thyroxine and TSH were measured in all the patients on entry. Patients were selected at random to be treated with two different regimens of l-thyroxine. Four patients died with the mortality rate being 36.4%. The patients in coma at entry had significantly higher mortality rates than those with minor degrees of consciousness (75% vs 14.3% respectively, P=0.04). The surviving patients had significantly higher Glasgow scores than those who died (11.85+/-2.3 vs 5.25+/-2.2 respectively, P<0.001). Comparison of the mean values of APACHE II scores between the surviving group and those who died was significantly different (18.0+/-2.08 vs 31.5+/-2.08 respectively, P<0.0001). The degree of consciousness, the Glasgow score and the severity of the illness measured by APACHE II score on entry were the main factors that determined the post-treatment outcome of patients with myxoedema coma.

[Incidence, clinical picture and treatment of hypothyroid coma. Results of a survey]. / Häufigkeit, klinisches Bild und Behandlung des hypothyreoten Komas. Ergebnis einer Umfrage.

BACKGROUND: Myxedema coma is a severe life-threatening clinical state with a high mortality rate. Very often symptoms are masked because of concurrent illnesses. There are no data available about the incidence and prevalence of this disease. Therefore we conducted a survey in the Federal Republic of Germany between 1993 and 1995 by a questionnaire on the occurrence of myxedema coma. METHODS: Questionnaires were mailed to 800 departments of medicine. RESULTS: We received 168 questionnaires for further evaluation. Among those, 24 patients were classified as myxedema coma, but according to clinical data we could reclassify 12 patients as myxedema coma and 12 patients as severely hypothyroid but without coma. The mean age of the patients was 73 years. The etiology was Hashimoto's thyroiditis in 16 patients (67%), in 15 patients the thyroid disease was unknown. In 6 patients thyroid hormone therapy was withdrawn after thyroid surgery. One patient became hypothyroid after radioiodine therapy and 1 patient had secondary hypothyroidism. 19 of the 24 patients received i.v. thyroxine therapy and 11 patients received corticosteroids additionally. Six patients (25%) died. CONCLUSION: These data emphasize that myxedema coma is a rare disease (24 patients within two years in Germany) occurring especially in older patients and is associated with a high mortality rate also in non-comatose patients. In the majority of the patients myxedema coma was the first manifestation of thyroid disease.