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==Laboratory Findings==
==Laboratory Findings==
Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.<ref name="pmid11130234">{{cite journal |vauthors=Wall CR |title=Myxedema coma: diagnosis and treatment |journal=Am Fam Physician |volume=62 |issue=11 |pages=2485–90 |year=2000 |pmid=11130234 |doi= |url=}}</ref>
Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.<ref name="pmid11130234">{{cite journal |vauthors=Wall CR |title=Myxedema coma: diagnosis and treatment |journal=Am Fam Physician |volume=62 |issue=11 |pages=2485–90 |year=2000 |pmid=11130234 |doi= |url=}}</ref><ref name="pmid17724938">{{cite journal |vauthors=Finora K, Greco D |title=Hypothyroidism and myxedema coma |journal=Compend Contin Educ Vet |volume=29 |issue=1 |pages=19–31; quiz 31–2 |year=2007 |pmid=17724938 |doi= |url=}}</ref>
*Serum TSH should be measured to distinguish primary hypothyroidism from the central.
*Serum TSH should be measured to distinguish primary hypothyroidism from the central.
*TSH might not be so as would be expected due to the presence of concomitant severe systemic disease("sick hypothyroid syndrome").
*TSH might not be so as would be expected due to the presence of concomitant severe systemic disease("sick hypothyroid syndrome").

Revision as of 16:40, 10 October 2017

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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

Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.

Laboratory Findings

Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.[1][2]

  • Serum TSH should be measured to distinguish primary hypothyroidism from the central.
  • TSH might not be so as would be expected due to the presence of concomitant severe systemic disease("sick hypothyroid syndrome").
  • The use of certain drugs such as dopamine or glucocorticoids also decrease the levels of TSH.
  • The levels of T4 and T3 (total and free fractions) will always be low.
  • In all cases measure cortisol and ACTH to evaluate or rule out the presence of primary adrenal insufficiency or secondary school.
  • CBC shows Anemia, leucopenia, hyponatremia, increased lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and transaminases, hypercholesterolemia, increased creatinine and hypoglycemia.
  • Blood gases will reveal hypoxemia, hypercapnia and acidosis.

Approach to Patient with altered level of conciousness

 
 
 
 
 
 
 
 
Altered level of concoiousness
COMA
Stupor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess ABC
Airway
Breathing
Circulation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Seizure activity
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Identity the problem
reassess
 
 
 
 
 
 
 
 
 
 
 
Diagnostic and therapatic administration of
Thiamine 100mg
Dextrose 50ml, 50%
Nalaoxone 0.4mg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No change in level of conciousness
 
 
 
 
 
 
 
Improvement in conciousness
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform labaratory tests
CBC,Thyroid studies
Blood glucose, CMP,BUN, creatinine
LFT's
Serum osmolality
 
 
 
 
 
 
 
Hypoglycemia
or
Narcotic overdose
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abnormal
 
 
 
 
 
 
 
Normal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
↑TSH
↓T3 and T4
 
↑WBC
 
CMP abnormal
 
 
 
Check Head CT/MRI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Myxedema coma
 
Sepsis
Meningitis
Encephalitis
 
Toxic encephalopathy
 
Abnormal
 
 
 
 
Normal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stroke
Brain tumor
Intracranial bleeding
Cerebral edema
Brain abscess
 
 
 
 
Perform
lumbar puncture
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abnormal
 
 
 
 
 
 
 
Normal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased ICP
Infection
 
 
 
 
 
 
 
Psyciatric Disorders
 

References

  1. Wall CR (2000). "Myxedema coma: diagnosis and treatment". Am Fam Physician. 62 (11): 2485–90. PMID 11130234.
  2. Finora K, Greco D (2007). "Hypothyroidism and myxedema coma". Compend Contin Educ Vet. 29 (1): 19–31, quiz 31–2. PMID 17724938.