Myxoedema Crisis Flashcards
Untreated Hypothyroidism can lead to what endocrine emergency?
myxoedema crisis
what happens to thyroid levels in myxoedema crisis?
decrease a lot
2 most common presenting symptoms?
confusion and hypothermia
mortality rate of myxoedema crisis?
50%
triggers for a myxoedema crisis?
Hypothermia infections amiodarone surgery – resected thyroid or irradiation of thyroid haemorrhage trauma
pt usually have a history of what?
state the obvious
Hx of hypothyroidism
why is there skin swelling/oedema?
mucopolysaccharide deposition in dermis skin swells
sign at the abdomen?
abdo distention/ ascites
why do you get ascites?
mucopolysaccharide infiltration at gut too
sign on CXR when looking at lungs?
pleural effusion
↓↓↓T4 causes loss of what main things?
(think about functions)
-3
↓metabolic activity
↓SNS
↓O2 consump
most common gut symptom?
constipation
what happens to vitals?
-4
↓HR
↓BP
↓temp
↓O2
results on ABG?
-3
↓O2
↑CO2
↓pH
medical names for ↓O2 ↑CO2 ↓pH?
hypoxia, hypercapnia, resp acidosis
what happens to renal function?
bad renal function, ↓GFR
what happens to heart function?
-2
why?
-2
↓CO, ↓HR
↓SNS & ↓O2 consumption so less heart contractility
why does renal function decrease?
-3
↓CO, ↓HR, ↓BP
↓GFR causes body to respond by releasing what hormone?
-1
effect on U+Es?
-1
↑ADH to respond
↓Na+
Myxoedema Crisis effect on BP?
↓BP
why is there confusion?
-2
↓Na+ > affects brain > confusion
↓O2 consumption at brain + ↓BP(less blood to brain) > confusion
why is there ↓RR?
Ventilatory drive gets depressed
U&Es results?
-2
↓Na+ ↑creatinine
why is there ↑creatinine?
-1
↓GFR
why is there ↓BP?
-3
↓CO, ↓HR, ↓SNS
CNS symptoms of myxoedema crisis?
-3
confusion, apathy, psychosis
GCS score?
up or down
down
what happens to Temp?
↓
↓Temp is called what?
Hypothermia
how will the face look? (what features do you see)
-4
a face that looks like this in myxoedema crisis is called what?
puffy face, macroglossia, ptosis, periorbital oedema
Myxoedematous face
which bloods do you order?
-6
TFTs FBC BG U&Es ABG Serum cortisol
which imaging do you order?
CXR
which graph do you order?
ECG
what are you looking for on ECG?
-1
Bradycardia
what are you looking for on CXR ?
-1
pleural effusion
which screen do your order?
(think about the triggers)
what does this screen comprise of?
-2 main things
Infection screen
blood culture & urine culture
pt suspected of myxoedema crisis.
+ve result on TFTs?
-3
↓TSH ↓T4 ↓T3
pt suspected of myxoedema crisis.
+ve result on FBC?
-1
↓Hb, anaemia
pt suspected of myxoedema crisis.
+ve result on blood glucose?
-1
↓
pt suspected of myxoedema crisis.
+ve result on U&Es?
-2
↓Na+ ↑creatinine
pt suspected of myxoedema crisis.
+ve result on ABG?
-3
↓O2 ↑CO2 ↓pH
pt suspected of myxoedema crisis.
+ve result on serum cortisol?
what should you assume before test result even comes back?
↓cortisol
that ↓cortisol is decreased (i.e. adrenal insufficiency) and you need to treat
pt suspected of myxoedema crisis.
where do you send?
ITU
main cause of death in myxoedema crisis?
resp failure
pt has myxoedema crisis.
how you treat Hypothermia?
slow warming
pt has myxoedema crisis.
what do you need to give IV?
- 2 things
- and how much
IV thyroid (100-500 μg) IV hydrocortisone (100mg)
pt has myxoedema crisis.
what do you need to give IV?
- 2 things
- and how much
IV thyroid (100-500 μg) IV hydrocortisone (100mg)
pt has myxoedema crisis.
trigger was infection.
what else do you give now?
antibiotics
pt has myxoedema crisis.
what do you need to give IV?
- 2 things
- and how much
IV thyroid (100-500 μg) IV hydrocortisone (100mg)
