Coma in Myxedema

Forester, C. F.

doi:10.1001/archinte.1963.03620300054010

Cited by 52 publications

(7 citation statements)

References 29 publications

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“…The treatment of myxoedema coma has often been discussed in the literature because of the high mortality of this serious condition (Forester 1963;Holvey et al 1964;Catz & Russell 1961;Nickerson et al 1960). Since the disease is very uncommon, a systematic evaluation of possible treatment strate¬ gies had been difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, patients were treated with large doses of triiodothyronine (T3) and mortality ranged between 50 to 80%. A frequent cause of death was circulatory derangement (Forester 1963;Catz & Russell 1961 ;Nickerson et al 1960). When T4 is used for replacement it has to be converted to T3 before it can exert most of its effects (Ingbar & Braverman 1975;Oppenheimer et al 1972;Surks et al 1973).…”

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confidence: 99%

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Treatment of myxoedema coma factors associated with fatal outcome

Hylander

Rosenqvist

1985

Acta Endocrinologica

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Treatment of myxoedema coma has been associated with a high mortality. The causes of death were analysed in this paper by retrospective study of the records of 11 myxoedema coma patients. The serum thyroxine (T4) and triiodothyronine (T3) levels were estimated retrospectively from the amounts of hormone given to the patients by a two-compartment model. Seven patients died and 4 survived. The patients who died were significantly older (78.9 \ m=+-\ 2.2 years, mean \ m-+-\ sem) than those who survived (66.8 \ m=+-\ 3.7 years). The initial heart rate was lower in the deceased group, but both groups had increased their heart rate on treatment. The surviving patients showed an increase in body temperature during the first 3 days of treatment, in contrast to the patients who eventually died. The deceased patients had received larger amounts of thyroid hormone and had calculated levels of T3 that were nearly twice as high as those of the surviving patients. Old age and a high serum level of T3 are determinants for the fatal outcome of myxoedema coma. Our analysis underscores the importance of using a cautious replacement regimen in myxoedema coma patients.Myxoedema coma is uncommon and relatively few patients have been described in the literature since the first report (Ord 1879). The incidence of myxoedema coma is not known. A report summa¬ rizing data on patients published between 1911 -1961 included 76 myxoedema coma patients (For¬ ester 1963). Thereafter only a few case reports have appeared (Khaleeli

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Treatment of myxoedema coma factors associated with fatal outcome

Hylander

Rosenqvist

1985

Acta Endocrinologica

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“…The high mortality rate has been widely reported (Forester, 1963;Blum, 1972). The elderly are often affected (Newmark, Hemathongkam and Share, 1974) and co-existent disease commonly complicates management, occasionally causing coma (Rosenberg, 1968;Royce, 1971).…”

Section: Introductionmentioning

confidence: 99%

Myxoedema coma. A report on five successfully treated cases

Khaleeli

1978

Postgraduate Medical Journal

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“…Hyperthermia then results from a combination of loss of voluntary control mechanisms from stupor or coma, decreased calorigenesis from thyroid deficiency, and decreased shivering presumably from impaired hypothalamic regulation [24,25 ].…”

Section: Cause and Pathogenesismentioning

confidence: 99%

“…Ocular movement abnormalities are otherwise unusual in hypothermia [ 101 ]. Although hypothyroidism and panhypopituitarism are rare causes of hypothermia, the diagnosis may be difficult to make because the clinical presentations of these conditions are quite similar [25]. Several factors make hypothyroidism quite unlikely as a cause: The patient is male, the disorder presents during a season other than winter, the presence of a low or normal cholesterol level, and the absence of myxedema facies.…”

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confidence: 99%

Disorders of Temperature Control: Hypothermia, Part III

Curley

Irwin

1986

J Intensive Care Med

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Hypothermia, defined as a body core temperature below 35°C, results from exposure to cold, drugs, metabolic dysfunction, or nervous system or skin disorders. The diagnosis and clinical assessment of patients with hypothermia should be based on a thorough knowledge of the characteristic physiologic changes that accompany hypothermia and affect all organ systems. Morbidity and mortality resulting from hypothermia may be reduced when physicians anticipate the well-known complications of hypothermia and carefully rewarm the patient.The rate and method of rewarming must be individualized, taking into account available resources and the patient's cardiopulmonary status and underlying disease.In Parts I and II of this review, the normal physiology of temperature regulation and three hvperthermic syndromes-heat stroke, malignant hyperthermia, and neuroleptic malignant syndrome-were reviewed. This section focuses on unintentional hypothermia and reviews in detail its pathogenesis, pathophysiologic factors, diagnosis, and management. Iatrogenic and intentional hypothermia in the perioperative setting is briefly discussed.Hypothermia, defined as a core temperature below 35°C, is not uncommon; it occurs at all ambient temperatures and in patients of all ages, although more commonly in the elderly. During the winter in Great Britain, 0.7% of all hospital admissions [1], 3% of elderly patients admitted [2], and at least 10% of otherwise healthy elderly individuals examined at home [3] had core temperatures in the hypothermic range. Review of death certificates in the United States reveals an average mortality rate for hypothermia of 0.22 per 100,000 individuals; white women have the lowest rates, and nonwhite men, the highest [4]. When all data are reviewed, the overall mortality from hypothermia in the United States has been conservatively estimated at 17 deaths per million of the general population peryear {5]. The mortality rate for treated hypothermia ranges from 12% [6] to 73% [7]. Cause and PathogenesisAlthough hypothermia can occur in all climates, at nearly all ambient temperatures, and at every age, the most frequent causes (vide infra) appear to be exposure, use of depressant drugs, and hypoglycemia. The elderly, because of a &dquo;normal&dquo; impairment of regulatory function, constitute a large portion of the patients who become hypothermic. A brief review of the causes of hypothermia (Table 1) at UNIVERSITE LAVAL on July 1, 2015 jic.sagepub.com Downloaded from 271 Table 1. Causes of Hypothermia and their pathogenesis will help develop a rational approach to treatment.Exposure to Cold Fatal hypothermia occurs frequently, even in the healthy young adult who simply has been overexposed to the elements. Wet, wind, and exhaustion contribute to increased loss of body heat. Wet clothing loses 90% of its insulating value [8], rendering soaked individuals effectively nude. Exposure to rain or snow was believed to contribute greatly to the development of hypothermia in 15 of 23 incidents in hikers discussed in one rev...

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Coma in Myxedema

Cited by 52 publications

References 29 publications

Treatment of myxoedema coma factors associated with fatal outcome

Treatment of myxoedema coma factors associated with fatal outcome

Myxoedema coma. A report on five successfully treated cases

Disorders of Temperature Control: Hypothermia, Part III

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