myxedema coma

• related: Endocrine, hypothyroidism
• tags: #note

History

• personal or family hx of autoimmune disease
• Grave's disease hx
• recent pregnancy
• medications: amiodarone, lithium
• Hx of brain surgery, pituitary surgery, head trauma
• trigger: any stress, infection/MI

Sx

• AMS: slow or psychosis
• hypothermia
• slowed organ function
• non pitting edema everywhere
• pericardial effusion
• heart block
• bowel edema/constipation: distended abd
• slowed reflex
• hyponatremia
• hypoglycemia

Labs

• TSH, free T4, total T3
• cortisol, ACTH

Treatment

• IV levothyroxine (T4): 200 mcg followed by 75% of patient's weight based dosing
  • do not use T3, contrary to uptodate recs
  • avoid for tachycardia. If stable, go back to PO dosing
• stress dose steroids: steroids and cortisol
  • continue until ruled out adrenal insufficiency
• supportive care
  • fluids, pressors
  • vent
  • pacing
  • empiric abx