Myxoedema Crisis

Question 1

Untreated Hypothyroidism can lead to what endocrine emergency?

Answer 1

myxoedema crisis

Question 2

what happens to thyroid levels in myxoedema crisis?

Answer 2

decrease a lot

Question 3

2 most common presenting symptoms?

Answer 3

confusion and hypothermia

Question 4

mortality rate of myxoedema crisis?

Answer 4

50%

Question 5

triggers for a myxoedema crisis?

Answer 5

Hypothermia
infections 
amiodarone 
surgery – resected thyroid or irradiation of thyroid 
haemorrhage 
trauma

Question 6

pt usually have a history of what?

state the obvious

Answer 6

Hx of hypothyroidism

Question 7

why is there skin swelling/oedema?

Answer 7

mucopolysaccharide deposition in dermis  skin swells

Question 8

sign at the abdomen?

Answer 8

abdo distention/ ascites

Question 9

why do you get ascites?

Answer 9

mucopolysaccharide infiltration at gut too

Question 10

sign on CXR when looking at lungs?

Answer 10

pleural effusion

Question 11

↓↓↓T4 causes loss of what main things?
(think about functions)
-3

Answer 11

↓metabolic activity
↓SNS
↓O2 consump

Question 12

most common gut symptom?

Answer 12

constipation

Question 13

what happens to vitals?

-4

Answer 13

↓HR
↓BP
↓temp
↓O2

Question 14

results on ABG?

-3

Answer 14

↓O2
↑CO2
↓pH

Question 15

medical names for ↓O2 ↑CO2 ↓pH?

Answer 15

hypoxia, hypercapnia, resp acidosis

Question 16

what happens to renal function?

Answer 16

bad renal function, ↓GFR

Question 17

what happens to heart function?
-2

why?
-2

Answer 17

↓CO, ↓HR

↓SNS & ↓O2 consumption so less heart contractility

Question 18

why does renal function decrease?

-3

Answer 18

↓CO, ↓HR, ↓BP

Question 19

↓GFR causes body to respond by releasing what hormone?
-1

effect on U+Es?
-1

Answer 19

↑ADH to respond

↓Na+

Question 20

Myxoedema Crisis effect on BP?

Answer 20

↓BP

Question 21

why is there confusion?

-2

Answer 21

↓Na+ > affects brain > confusion

↓O2 consumption at brain + ↓BP(less blood to brain) > confusion

Question 22

why is there ↓RR?

Answer 22

Ventilatory drive gets depressed

Question 23

U&Es results?

-2

Answer 23

↓Na+ ↑creatinine

Question 24

why is there ↑creatinine?

-1

Answer 24

↓GFR

Question 25

why is there ↓BP? | -3

Answer 25

↓CO, ↓HR, ↓SNS

Question 26

CNS symptoms of myxoedema crisis? | -3

Answer 26

confusion, apathy, psychosis

Question 27

GCS score? | up or down

Answer 27

down

Question 28

what happens to Temp?

Answer 28

↓

Question 29

↓Temp is called what?

Answer 29

Hypothermia

Question 30

how will the face look? (what features do you see) -4 a face that looks like this in myxoedema crisis is called what?

Answer 30

puffy face, macroglossia, ptosis, periorbital oedema Myxoedematous face

Question 31

which bloods do you order? | -6

Answer 31

``` TFTs FBC BG U&Es ABG Serum cortisol ```

Question 32

which imaging do you order?

Answer 32

CXR

Question 33

which graph do you order?

Answer 33

ECG

Question 34

what are you looking for on ECG? | -1

Answer 34

Bradycardia

Question 35

what are you looking for on CXR ? | -1

Answer 35

pleural effusion

Question 36

which screen do your order? (think about the triggers) what does this screen comprise of? -2 main things

Answer 36

Infection screen blood culture & urine culture

Question 37

pt suspected of myxoedema crisis. +ve result on TFTs? -3

Answer 37

↓TSH ↓T4 ↓T3

Question 38

pt suspected of myxoedema crisis. +ve result on FBC? -1

Answer 38

↓Hb, anaemia

Question 39

pt suspected of myxoedema crisis. +ve result on blood glucose? -1

Answer 39

↓

Question 40

pt suspected of myxoedema crisis. +ve result on U&Es? -2

Answer 40

↓Na+ ↑creatinine

Question 41

pt suspected of myxoedema crisis. +ve result on ABG? -3

Answer 41

↓O2 ↑CO2 ↓pH

Question 42

pt suspected of myxoedema crisis. +ve result on serum cortisol? what should you assume before test result even comes back?

Answer 42

↓cortisol that ↓cortisol is decreased (i.e. adrenal insufficiency) and you need to treat

Question 43

pt suspected of myxoedema crisis. where do you send?

Answer 43

ITU

Question 44

main cause of death in myxoedema crisis?

Answer 44

resp failure

Question 45

pt has myxoedema crisis. how you treat Hypothermia?

Answer 45

slow warming

Question 46

pt has myxoedema crisis. what do you need to give IV? - 2 things - and how much

Answer 46

``` IV thyroid (100-500 μg) IV hydrocortisone (100mg) ```

Question 47

pt has myxoedema crisis. what do you need to give IV? - 2 things - and how much

Answer 47

``` IV thyroid (100-500 μg) IV hydrocortisone (100mg) ```

Question 48

pt has myxoedema crisis. trigger was infection. what else do you give now?

Answer 48

antibiotics

Question 49

pt has myxoedema crisis. what do you need to give IV? - 2 things - and how much

Answer 49

``` IV thyroid (100-500 μg) IV hydrocortisone (100mg) ```