Myxedema coma diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The diagnosis of myxedema coma is made when the three key diagnostic features of myxedema coma are present, which include altered mental status, hypothermia or absence of fever and a precipitating event such as cold exposure, infection, drugs.

Diagnostic criteria

The diagnosis of myxedema coma is made when the following three key diagnostic features are present, which include:

• Altered mental status
• Hypothermia or absence of fever
• Precipitating event (cold exposure, infection, drugs)

Diagnostic scoring

• Traditionally different scoring systems have been employed to assess the level of awareness or degree of severity of myxedema coma such as the Glasgow scale and others such as the SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation) assessing the severity of an illness and predict mortality.

Diagnostic Scoring System for Myxedema Coma
Component	Variable		Points	Component	Variable	Points
Thermoregulatory dysfunction	>35		0	Gastro-intestinal	Anorexia/abdominal pain/constipation	5
	32-35		10		Decreased intestinal motility	15
	<32		20		Paralytic ileus	20
Central nervous system effects	Somnolent/lethargic		10	Precipitating event	Absent	0
	Obtunded		15		Present	10
	Stupor		20	Metabolic disturbances	Hyponatremia	10
	Coma/seizures		30		Hypoglycemia	10
Cardiovascular	Bradycardia	Absent	0		Hypoxemia	10
		50-59	10		Hypercarbia	10
		40-49	20		Decrease in GFR	10
	EKG changes		10	Others	Pleural effusions	10
	Pericardial effusion		10		Pulmonary edema	15
	Cardiomegaly		15		Hypotension	20
Abbreviations: EKG = electrocardiogram; GFR = glomerular filtration rate. A score of 60 or higher is highly suggestive/diagnostic of myxedema coma. A score of 25 to 59 is suggestive of risk for myxedema coma, and a score below 25 is unlikely to indicate myxedema coma. Other EKG changes: QT prolongation, or low voltage complexes, or bundle branch blocks, or nonspecific ST-T changes, or heart blocks

• Diagnostic scoring of myxedema coma
  • A score greater than 60 is highly suggestive / diagnosis of myxedema coma.
  • A score between 29-59 is suggestive of coma risk myxedema.
  • A score lower than 25 makes the diagnosis unlikely of myxedema coma.