myxedema coma
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
Backlinks