This document discusses hypothyroidism and myxedema coma. It begins with an introduction defining hypothyroidism and its causes. Myxedema coma is described as a metabolic crisis characterized by uncorrected hypothyroidism and precipitating stressors causing mental status changes, hypothermia, and other symptoms. Diagnosis involves clinical evaluation and lab tests. Treatment involves supportive care and thyroid hormone replacement, with myxedema coma being a medical emergency. Special populations like pregnant and elderly patients require careful management.

1. HYPOTHYROIDISM
AND
MYXEDEMA COMA
Dr.Soma Sekhara Reddy
Emergency Medicne

2. Objectives
 Introduction
 Clinical features
 Myxedema coma
 Diagnosis
 Lab investigations
 Treatment
 Special populations
 Disposition

3. INTRODUCTION
 Definition : Insufficient thyroid hormone
production that causes slowed metabolism
 Types : Primary
Secondary

5. Common causes
 Primary : Autoimmune
Thyroiditis (post partum)
Iodine deficiency
Post ablation/radiation/surgical
Infiltrative diseases
Drugs ( Li, Iodine ,Amiodarone)
Congenital

6. Secondary :
 Panhypopituitarism
 Pituitary adenoma
 Infiltrative causes (e.g., hemochromatosis,
sarcoidosis)
 Tumors impinging on the hypothalamus
 History of brain irradiation
 Infection (e.g., tuberculosis)

8. CLINICAL FEATURES

9. CLINICAL FEATURES
CONSTITUTIONAL SYMPTOMS :
 cold intolerance
 weight gain
 Weakness
 Lethargy and fatigue
 Hypothermia
 Hoarse or deep voice, and slow speech

10. NEUROPSYCHIATRIC SYMTOMS:
 Delayed deep tendon reflexes - biceps or
Achilles
 Dementia
 Psychosis
 Paresthesias
 Depression
 Poor memory
 Confusion
 Ataxia.

11. CARDIOPULMONARY SYMPTOMS :
 Angina
 Bradycardia
 Distant heart sounds
 Low voltage on the ECG
 Pericardial or pleural effusions
 Cardiomyopathy
 Hypoventilation.

12. GASTROINTESTINAL:
 Constipation
 Ascitis
Gynaecological:
 Infertility
 DUB

13. DERMATOLOGICAL:
 Dry skin
 Hair loss
 Non-pitting edema
 Facial swelling
 Ptosis
 Macroglossia
 Periorbital edema.

14. MYXEDEMA COMA /CRISIS
 State of metabolic and multi organ dysfunction.
 Characterised by pre existing uncorrected
hypothyroidism , mental status changes ,
hypothermia and precipitating stressors.

15. Medical emergency:
 Bradycardia
 Hypotension
 Hypothermia
 Hypoventilation
 AMS / COMA

16. Precipitating factors:
 Infection
 Cold exposure /Trauma /Burns
 M I / CHF / CVA / GI hemorrhage
 Metabolic (hypoxia, hypercapnia,
hyponatremia, and hypoglycemia)
 Surgery
 Drugs - Anesthetics ,B -blockers, Amiodarone
 Thyroid medication noncompliance.

17. Diagnosis
 Clinical
 Basics , ABG
 Thyroid profile
 Other labs – depends

18. Treatment
 Initiated without waiting for laboratory
confirmation.
 supportive care (A,B,C
, oxygen, fluids, inotropes, blankets, and steroids)
 Thyroid hormone replacement (supplementing
with T4, T3, or combination of both)
 Identification and treatment of precipitating
factors

19. Management
 ? Active rewarming
 ? T 3 or T 4 or both or TSH and ? Route
 ? Steroid and when
 ? IV fluids

20. Special population - careful
 Pregnants:
 Elderly :
 Cardiac instability:

21. Disposition
 High mortality : 30 to 60 %
 ICU admission

22. Take home points
 Recognition
 Its combo pack :Myxedema + stressors
 Steroid before thyroid hormone
 T3 / T4 , I.V / Oral - depends , take second
opinion
 Special ppl should get special

23. Queries ..?

24. Thank you