What is the treatment for myxedema coma?
Which of the following is NOT part of the recommended treatment for myxedema coma? Therapeutic hypothermia. The adrenal cortex is devoted to the synthesis of corticoseteroid hormones from cholesterol. True. The role of the adrenal cortex gland includes the regulation of extracellular fluid, the
What are the possible complications of surgery for patients with myxedema coma?
What is the best thyroid medication for myxedema coma?
What is a myxedema coma?
Myxedema coma is a medical emergency that requires immediate attention. If the diagnosis is suspected, immediate management is necessary before confirming the diagnosis due to the high associated mortality rate. Patients with myxedema coma should be managed in an intensive care unit with continuous cardiac monitoring.
How to treat hypothermia?
Treat hypothermia with passive rewarming using ordinary blankets and a warm room. Active rewarming using external devices carries a risk of vasodilatation and worsening hypotension and should be avoided. The use of a rectal probe helps to determine the true core temperature and to monitor rewarming.
How long does it take to ventilate a patient?
Mechanical ventilation is commonly required during the first 36-48 hours, but some patients require prolonged respiratory support for as long as 2-3 weeks.
Is thyroid hormone used in myxedema?
The ideal mode of therapy and doses of thyroid hormone therapy in myxedema coma remain controversial due to the rarity of the condition and lack of clinical trials. Some clinicians favor the administration of levothyroxine (T4), while others prefer a combination of T4 and liothyronine (T3). [ 3, 4, 30, 31] The American Thyroid Association recommends combination therapy with T4 and T3. [ 32]
Can cold climates cause myxedema?
They should understand the symptoms that signal the condition and the need to seek medical attention for appropriate testing. In cold climates, inadequately heated residences are a significant cause of myxedema coma/crises in patients with undiagnosed or inadequately treated hypothyroidism.
Can dexamethasone be used for ACTH?
Dexamethasone has the advantage of not affecting the serum cortisol concentration and can be used immediately without affecting the results of the ACTH stimulation test, which can be performed at any time. If the test is normal, corticosteroids can be stopped without tapering.
Does T4 therapy worsen myocardial ischemia?
The lower end of the dosing range is recommended in older patients, those at risk for cardiac complications such as myocardial infarction and arrhythmias, and in patients with coronary artery disease, since full-dose T4 therapy may worsen myocardial ischemia by increasing myocardial oxygen consumption.
Airway Management
Thyroid Hormone Replacement
- The ideal mode of therapy and doses of thyroid hormone therapy in myxedema coma remain controversial due to the rarity of the condition and lack of clinical trials. Some clinicians favor the administration of levothyroxine (T4), while others prefer a combination of T4 and liothyronine (T3).[3, 4, 30, 31] The American Thyroid Association recommends combination therapy with T4 …
Glucocorticoid Therapy
- Patients with primary hypothyroidism may have concomitant primary adrenal insufficiency, while patients with secondary hypothyroidism may have associated hypopituitarism and secondary adrenal insufficiency. The other rationale for treatment with corticosteroids is the potential risk of precipitating acute adrenal insufficiency caused by the accelerated metabolism of cortisol that f…
Supportive Measures
- Treat hypothermia with passive rewarming using ordinary blankets and a warm room. Active rewarming using external devices carries a risk of vasodilatation and worsening hypotension and should be avoided. The use of a rectal probe helps to determine the true core temperature and to monitor rewarming. Treat associated infection. Given the severity of the condition, infection sho…