Predictors of outcome in myxoedema coma: a study from a tertiary care centre

Dutta, Pinaki; Bhansali, Anil; Masoodi, Shriq Rashid; Bhadada, Sanjay; Sharma, Navneet; Rajput, Rajesh

doi:10.1186/cc6211

Cited by 120 publications

(78 citation statements)

References 20 publications

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“…Triiodothyronine can be added to therapy at 10-20 mg bolus followed by 10 μg every 4-6 hours. This initial plan can be followed by L-T4 maintenance therapy once the patient is stable (216,217) (B,B).…”

Section: How To Treat Myxedema Coma?mentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

114

108

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Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

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Section: How To Treat Myxedema Coma?mentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

114

108

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“…A precipitating factor was evident in only 34 of 77 cases in an analysis of myxedema coma reported by Forester (7). Sepsis was the most common precipitating factor among the 23 patients with myxedema coma in a study reported by Dutta et al (9).…”

Section: Discussionmentioning

confidence: 89%

“…Although elevated TSH levels are common in patients with myxedema coma, it is not a sine qua non. For example, patients with pituitary disease would not have elevated TSH levels but may have myxedema coma as has been reported (9). Thus, we have included TSH levels in our screening tool.…”

Section: Discussionmentioning

confidence: 99%

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Development of an objective tool for the diagnosis of myxedema coma

Chiong

Bammerlin

Mariash

2015

Translational Research

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Myxedema coma, a rare entity with a reported 25-65% mortality had no objective criteria for making the diagnosis when we began our study. We developed an objective screening tool for myxedema coma to more easily identify patients and examine the best treatment method in future prospective studies to reduce the mortality of this entity. We conducted a retrospective chart review to find all patients aged ≥ 18 years admitted with myxedema coma from 1/1/2005 through 6/13/2010 at Indiana University Health Methodist Hospital. Based both on our retrospective chart review and on literature-based accounts, we identified 6 criteria to diagnose myxedema coma. We identified 10 patients initially diagnosed with myxedema coma and established a control group consisting of 13 patients identified with altered mental status and elevated TSH levels. The six variables we created for the screening tool are heart rate, temperature, Glasgow coma scale, thyroid stimulating hormone, free T4, and precipitating factors. The screening tool has a sensitivity and specificity of about 80%. We ran a logistic regression model using the 10 study patients and 13 controls with the 6 variables. No variables alone significantly contributed to the model. However, the overall model was highly significant (P = 0.012), providing strong support for a scoring system that uses these variables simultaneously. This screening tool enables physicians to rapidly diagnose myxedema coma to expedite treatment. A more refined diagnostic tool may be used in future clinical studies designed to determine the optimal treatment.

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“…The mortality rates may be as high as 25-60% even with best possible treatment [56][57][58][59][60] . It presents as central nervous system dysfunction, defective thermoregulation, and cardiopulmonary decompensation.…”

Section: Myxedema Comamentioning

confidence: 99%

Recent Advancement on Current Trend in the Management of Endocrine Emergency in Critically Ill Patient

Ferdous

Afsana

Qureshi

et al. 2016

J. Bangladesh Coll. Phys.

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Summary:Endocrine emergencies represent a group of potentially lifethreatening conditions that are frequently overlooked, resulting in delays in both diagnosis and treatment, factors that further contribute to their already high associated mortality rates. Although endocrine emergencies are often encountered in patients with a known endocrinopathy, the emergency may be the initial presentation in previously undiagnosed individuals. If these endocrine disorders are not rapidly identified or if specific treatment is delayed, significant complications or even death may occur. Careful evaluation of clinical history and a high degree of suspicion are the corner stone to diagnose such problems. Aggressive management of the patient is equally important as the complications are devastating and can prove highly fatal. The present article is an attempt to review some of the common endocrine emergencies in intensive care unit and the challenges associated with their diagnosis and management.

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Predictors of outcome in myxoedema coma: a study from a tertiary care centre

Cited by 120 publications

References 20 publications

Clinical practice guidelines for the management of hypothyroidism

Clinical practice guidelines for the management of hypothyroidism

Development of an objective tool for the diagnosis of myxedema coma

Recent Advancement on Current Trend in the Management of Endocrine Emergency in Critically Ill Patient

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