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
- hyponatraemia
- ↑ CK
- ↑ serum cholesterol
- urinary retention
- constipation/ileus
infection
- hypothermia masking fever