Browsing by Subject "myxedema coma"

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    Development of an objective tool for the diagnosis of myxedema coma
    (Elsevier, 2015-09) Chiong, Yien Vickie; Bammerlin, Elaine; Mariash, Cary N.; Department of Medicine, IU School of Medicine
    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 January 1, 2005 through June 13, 2010 at Indiana University Health Methodist Hospital. On the basis of both our retrospective chart review and on literature 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 increased thyroid-stimulating hormone (TSH) levels. The 6 variables we created for the screening tool were heart rate, temperature, Glasgow coma scale, TSH, free thyroxine, 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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    Visual Hallucinations in a Patient with Myxedema Coma
    (American College of Physicians: Florida Chapter, 2020-03-28) Ayala Castillo, Crystal; Lugo, Adrian; Kanapathippillai, Narrani; Joseph, Aneeta J.; Ramamurthy, Guruswamy; Hegagi, Marwa
    Myxedema coma is a rare endocrine complication of hypothyroidism. Infections and cardiovascular diseases are the most common precipitants. Rarely, visual hallucinations are seen as part of the disease process, as they are more commonly caused by other psychiatric, pathological, metabolic, or hormonal disorders. We report a 72-year-old Caucasian male was brought to emergency room for rapid onset of weight gain, bilateral lower extremity edema, and visual hallucinations for a week. His past medical history was significant for with medical history of hypothyroidism, coronary artery disease status post one stent, essential hypertension, right renal cell carcinoma status post nephrectomy on chemotherapy, and chronic kidney disease stage 4. Initial laboratory results revealed hyponatremia, elevated liver enzymes, elevated thyroid stimulating hormone, low free thyroxine. A diagnosis of myxedema coma was established. He received thyroxine, mineralocorticoid supplement, hypertonic intravenous fluid, and intensive supportive care. Suspicion of myxedema coma should be treated without delay in order to avoid devastating outcomes.