Myxedema Coma
Myxedema coma may occur in a patient with hypothyroidism, either untreated or inadequately treated with thyroid hormone, who experiences a precipitating factor such as pneumonia, surgery, cold exposure, or treatment with medications that cause central ner
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Myxedema Coma Ines Donangelo and Glenn D. Braunstein
Précis 1. Clinical setting: A patient with long-standing undiagnosed/untreated hypothyroidism who develops lethargy and hypothermia following a precipitating factor (intercurrent illness, surgery, use of sedatives or narcotics, or exposure to cold). 2. Diagnosis: (a) History: Important clues include history of hypothyroidism, thyroid surgery, and radioactive iodine treatment. A precipitating factor is often identified. (b) Physical exam: The presence of a thyroidectomy scar on examination. Features of severe hypothyroidism may be present (dry skin, scaly elbows and knees, yellowness of skin without scleral icterus, coarse hair, puffiness of face and hands, thinning of the lateral aspects of the eyebrows, macroglossia, hoarseness, delayed relaxation phase of deep tendon reflexes, and bradycardia), in a patient with decreased mental status and hypothermia (core body temperature
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