Coma and Thyroid Dysfunction

Gilbert, Richard E.; Thomas, Garfield; Hope, Robert N.; Sasse, Anthony; Seeman, Ego; Doolan, Laurie; Jerums, George

doi:10.1177/0310057x9202000119

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…Infection was either treated or thought to be likely in 20 cases [3, 8, 10, 12–14, 19, 22, 23, 32], with all other potential precipitating causes reported much less frequently. Six episodes followed an operation (including curettage in two, cesarean section, hysterectomy, thyroid cancer metastasis biopsy, and thyroidectomy) [3, 8, 13, 21, 36, 38].…”

Section: Resultsmentioning

confidence: 99%

“…EEG was performed in 11 cases [11, 15, 20, 37], seven of which reported diffuse slowing [19, 30, 33, 38, 39, 42, 45]. LP was performed in 15 cases [11, 15, 19, 20, 22, 29, 30, 37, 38, 40, 42, 43, 45]. Low cerebrospinal fluid glucose level was reported in two cases (as 18 and 27 mg/dL) [22, 45].…”

Section: Resultsmentioning

confidence: 99%

“…A range of TFTs was reported. Most cases reported either total T4 [13–15, 21, 24, 25, 37–43, 45] or free T4 [15, 16, 19, 20, 22–24, 26–28, 30, 31, 33–36, 47]. The highest blood levels were noted in the acute levothyroxine overdose cases, with total T4 level of 600 μg/dL in a patient with preexisting chronic renal failure, an outlier that highly influenced the mean total T4 and T3 values [14].…”

Section: Resultsmentioning

confidence: 99%

“…Coma was present in 13 patients (30%) at hospital presentation [15, 17–19, 24, 27, 28, 35, 40, 42, 44, 45], in 17 (39%) within the first 2 days of hospitalization [8, 11, 14, 21–23, 25, 26, 29, 30, 33, 37, 41, 43], and in 14 (32%) from day 3 or later of hospitalization. For those presenting with coma, three were found unconscious [40, 42, 45] and one had a witnessed collapse [19]. Of the 17 patients who developed coma within the first 2 days of hospitalization, many were described as developing the condition rapidly or over minutes [8, 21, 29] to hours [8, 11, 25, 26, 30, 41, 43].…”

Section: Resultsmentioning

confidence: 99%

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Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports

Burmeister

2019

Journal of the Endocrine Society

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Context Coma is a serious manifestation of thyroid storm (TS) about which little is known. Objective To describe the features, duration, treatment response, and prognosis of coma in the setting of TS. Design Aggregate analysis of individual English-language case reports of coma in the setting of TS from 1935 to January 2019. Setting Hospitals. Patients Sixty-five cases were identified, 29 from case reports and 36 from case series. Interventions Antithyroid drugs, corticosteroids, beta-blockers, iodine, intubation, plasmapheresis, antibiotics, thyroidectomy, radioiodine, dialysis, and l -carnitine. Main Outcome Measures Awakening and death rates overall and in relation to administered treatments, day of coma presentation, and time from coma onset; symptoms associated with coma; TS and coma scales; thyroid and cerebrospinal laboratory tests; electroencephalogram; brain imaging; and autopsy results. Results Mortality was 38% in the setting of TS-related coma, 11% during the years 1978 to 2019 compared with 70% for 1935 to 1977. Both awakening and death commonly occurred within the first 2 days of coma onset. Reduction in total and free T4 values, and possibly also total T3 value, correlated with awakening from coma. Lower death rates were associated with use of antithyroid drugs, corticosteroids, beta-blockers, and intubation. Plasmapheresis was associated with awakening in 67% of cases but not with lower death rates. Conclusions Prognosis of coma associated with TS remains poor. Current guidelines for the early use of plasmapheresis in unresolving TS are advocated and should be considered urgently at the point of confusion or delirium in an effort to abort coma.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports

Burmeister

2019

Journal of the Endocrine Society

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“…The majority of the patients were women. Their age ranged from 3 to 77 years of age, but occurrences were most common between the 4th and 6th decades (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

mentioning

confidence: 99%

A Patient with Thyroid Storm Presenting with Apathetic Thyrotoxicosis and Features of Meningoencephalitis

Yang

Tey

et al. 2011

Thyroid

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Thyroid storm as precipitating factor in onset of coma in an elderly woman: case report and literature review

et al. 2004

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Thyroid storm is an uncommon but life-threatening manifestation of hyperthyroidism which, unless appropriately treated by combined therapy, causes 30-60% of deaths in hospitalized patients. Mental deterioration leading to apathy and eventually coma is a rare clinical presentation of this pathology, frequently observed in the elderly. We present the case of a 77-year-old hypertensive woman who was hospitalized for fast onset of coma, probably due to the unusual combination of a hypernatremic hyperosmolar state and an unexpected thyroid storm (TS). Although not definitely ascertained, the possible etiology was the hyperthyroid phase of chronic autoimmune thyreopathy (Hashitoxicosis). Notably, the significant adjunctive role of thyroid hyperfunction in the pathogenesis of coma was confirmed by the fact that, although metabolic abnormalities were overcome, complete and satisfactory recovery of the patient's mental and physical condition occurred only with normalization of thyroid hormones by antithyroid treatment. Our case highlights the importance of properly evaluating thyroid function in elderly patients who show a sudden progressive impairment in their mental condition, for early detection of potentially fatal conditions such as thyroid storm or myxedematous coma.

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Coma and Thyroid Dysfunction

Cited by 4 publications

References 9 publications

Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports

Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports

A Patient with Thyroid Storm Presenting with Apathetic Thyrotoxicosis and Features of Meningoencephalitis

Thyroid storm as precipitating factor in onset of coma in an elderly woman: case report and literature review

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