Amiodarone induced myxedema coma: Two case reports and literature review

Hawatmeh, Amer; Thawabi, Mohammad; Abuarqoub, Ahmad; Shamoon, Fayez

doi:10.1016/j.hrtlng.2018.03.012

Cited by 13 publications

(16 citation statements)

References 19 publications

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“…Several factors precipitating myxedema coma have been revealed, such as infection, myocardial infarction (MI), cold exposure, surgery [ 12 ], and the administration of sedative drugs [ 13 ]. Amiodarone also has a complex effect on the thyroid gland because its structure is similar to that of thyroid hormones [ 14 , 15 ]. In this case, fT3 levels were slightly lower, and TSH levels were higher after amiodarone administration for VT; consequently, the dose of LT3/LT4 needed to be increased.…”

Section: Discussionmentioning

confidence: 99%

Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

et al. 2021

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Background Myxedema coma, which occurs due to hypothyroidism, is a rare and life-threatening condition. Some patients have hemodynamic dysfunction, which consequently leads to cardiac arrest. The rarity of this condition makes it difficult to determine the cause of cardiac arrest. It is important to diagnose myxedema coma based on clinical findings, including physical examination and laboratory parameters. We present a case of undiagnosed and untreated hypothyroidism that initially caused myxedema coma and then led to cardiac arrest. Case presentation A 56-year-old woman who had no medical history was transferred to our hospital for the management of return of spontaneous circulation due to sudden cardiac arrest. Findings of laboratory tests revealed that she had hypothyroidism. On physical examination, she was found to have a puffy face, thin eyebrows, and severe systemic non-pitting edema. Therefore, the patient was clinically diagnosed with myxedema coma, which was the cause of cardiac arrest. She was treated with thyroid hormone and hydrocortisone, resulting in improvement in her general condition, except for the neurological dysfunction. Conclusions This case suggests that myxedema coma is caused by undiagnosed and untreated hypothyroidism, leading to sudden cardiac arrest. Our findings are useful in the differential diagnosis of hypothyroidism based on characteristic physical examination findings. Clinicians should be aware of the differential diagnosis of myxedema coma based on findings from physical examination and laboratory testing of thyroid function, and the treatment should be started immediately.

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Section: Discussionmentioning

confidence: 99%

Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

et al. 2021

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“…Some patients taking amiodarone may develop thyroid dysfunction in the form of amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH) The incidence of AIH ranges from 6% in countries with low iodine intake to 13% in countries with a high dietary iodine intake [5]. Females with positive thyroglobulin or anti-thyroid peroxidase antibodies have a 13-fold higher incidence of AIH when compared to males without thyroid antibodies [3]. Measurement of T3 hormone may be helpful in cases with thyroxine hormone replacement in the setting of myxedema coma arising during treatment with amiodarone due to its extrathyroidal T3 inhibitory effect.…”

Section: Discussionmentioning

confidence: 99%

“…This could explain the lack of response in our patient presenting in myxedema coma during amiodarone treatment. The diagnosis of this condition is more difficult in the elderly [3] when the T4 value is over 1 mcg/dl as seen in the euthyroid sick syndrome. In all the cases presented, we were only able to measure total thyroxine levels in the emergency department.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of myxedema coma should be immediately initiated once the diagnosis is suspected, even without laboratory confirmation. Management consists of supportive therapy, hormone replacement, and treatment of precipitating factors [1,3,4]. Intravenous thyroid hormone therapy replacement is the cornerstone in the treatment of patients.…”

Section: Discussionmentioning

confidence: 99%

“…It may also result from prolonged absence of thyroid hormone replacement treatment in patients with known hypothyroidism [1]. It has rarely been linked to drugs such as lithium [2] or amiodarone [3]. Prolonged hormone replacement therapy discontinuation has been related to hypothyroidism coma, although this is uncommon given the length of time required without thyroid replacement for this syndrome to appear.…”

Section: Introductionmentioning

confidence: 99%

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Myxedema coma: four patients diagnosed at the Internal Medicine Department of the Dr. Negrin University Hospital in Spain

Villalba¹,

Zulfiqar²,

Saint-Mezard³

et al. 2019

Pan Afr Med J

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Myxedema coma is a rare complication of hypothyroidism. Clinical examination may reveal hypotension, bradycardia, and hypothermia. Laboratory tests may show hyponatremia, lipid disorders, and elevations of creatine kinase, liver, and cardiac enzymes. We describe four cases diagnosed in our hospital during the period 1999-2017. The patients were related to amiodarone treatment, noncompliance with hormone replacement therapy, or a new diagnosis of hypothyroidism. Intravenous hormone replacement therapy was effective in three of the cases and one died. The outcome of this disease may be fatal as seen in one of our cases.

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Management of Myxedema Coma

Pinar

2020

Evidence-Based Critical Care

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Amiodarone induced myxedema coma: Two case reports and literature review

Cited by 13 publications

References 19 publications

Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

Myxedema coma: four patients diagnosed at the Internal Medicine Department of the Dr. Negrin University Hospital in Spain

Management of Myxedema Coma

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