myxoedema coma

Further along the spectrum of severity from hypothyroidism:

↓ level of consciousness, defective thermoregulation and cardiovascular collapse
Etiology All the things that can cause hypothyroidism including the problematic drugs; surgery, burns, trauma, stroke, sepsis
Clinical presentation
Pathogenesis
Diagnostic investigations
Management Resuscitation:
A-E, up to and including invasive ventilation if necessary

Address underlying cause:
Supplement thyroxine (parenterally?)
Stress dose steroids
Correct Na (hypervolaemic) ct Na br>Na

critical care considerations

airway

  • ↑ oedema

breathing

  • sleep apnoea
  • ↓ hypoxic respiratory drive

circulation

  • cardiogenic shock
  • see ECG changes in hypothyroidism

disability/neuro

  • seizures
  • delirium - psychosis

exposure

infection

  • hypothermia masking fever