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Endocrinology > Myxoedema Crisis > Flashcards

Myxoedema Crisis Flashcards

1
Q

Untreated Hypothyroidism can lead to what endocrine emergency?

A

myxoedema crisis

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2
Q

what happens to thyroid levels in myxoedema crisis?

A

decrease a lot

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3
Q

2 most common presenting symptoms?

A

confusion and hypothermia

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4
Q

mortality rate of myxoedema crisis?

A

50%

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5
Q

triggers for a myxoedema crisis?

A 
Hypothermia
infections 
amiodarone 
surgery – resected thyroid or irradiation of thyroid 
haemorrhage 
trauma
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6
Q

pt usually have a history of what?

state the obvious

A

Hx of hypothyroidism

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7
Q

why is there skin swelling/oedema?

A

mucopolysaccharide deposition in dermis  skin swells

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8
Q

sign at the abdomen?

A

abdo distention/ ascites

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9
Q

why do you get ascites?

A

mucopolysaccharide infiltration at gut too

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10
Q

sign on CXR when looking at lungs?

A

pleural effusion

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11
Q

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

A

↓metabolic activity
↓SNS
↓O2 consump

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12
Q

most common gut symptom?

A

constipation

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13
Q

what happens to vitals?

-4

A

↓HR
↓BP
↓temp
↓O2

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14
Q

results on ABG?

-3

A

↓O2
↑CO2
↓pH

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15
Q

medical names for ↓O2 ↑CO2 ↓pH?

A

hypoxia, hypercapnia, resp acidosis

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16
Q

what happens to renal function?

A

bad renal function, ↓GFR

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17
Q

what happens to heart function?
-2

why?
-2

A

↓CO, ↓HR

↓SNS & ↓O2 consumption so less heart contractility

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18
Q

why does renal function decrease?

-3

A

↓CO, ↓HR, ↓BP

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19
Q

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

effect on U+Es?
-1

A

↑ADH to respond

↓Na+

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20
Q

Myxoedema Crisis effect on BP?

A

↓BP

21
Q

why is there confusion?

-2

A

↓Na+ > affects brain > confusion

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

22
Q

why is there ↓RR?

A

Ventilatory drive gets depressed

23
Q

U&Es results?

-2

A

↓Na+ ↑creatinine

24
Q

why is there ↑creatinine?

-1

A

↓GFR

25
Q

why is there ↓BP?

-3

A

↓CO, ↓HR, ↓SNS

26
Q

CNS symptoms of myxoedema crisis?

-3

A

confusion, apathy, psychosis

27
Q

GCS score?

up or down

A

down

28
Q

what happens to Temp?

A

↓

29
Q

↓Temp is called what?

A

Hypothermia

30
Q

how will the face look? (what features do you see)
-4

a face that looks like this in myxoedema crisis is called what?

A

puffy face, macroglossia, ptosis, periorbital oedema

Myxoedematous face

31
Q

which bloods do you order?

-6

A 
TFTs 
FBC 
BG 
U&Es 
ABG 
Serum cortisol
32
Q

which imaging do you order?

A

CXR

33
Q

which graph do you order?

A

ECG

34
Q

what are you looking for on ECG?

-1

A

Bradycardia

35
Q

what are you looking for on CXR ?

-1

A

pleural effusion

36
Q

which screen do your order?
(think about the triggers)

what does this screen comprise of?
-2 main things

A

Infection screen

blood culture & urine culture

37
Q

pt suspected of myxoedema crisis.

+ve result on TFTs?
-3

A

↓TSH ↓T4 ↓T3

38
Q

pt suspected of myxoedema crisis.

+ve result on FBC?
-1

A

↓Hb, anaemia

39
Q

pt suspected of myxoedema crisis.

+ve result on blood glucose?
-1

A

↓

40
Q

pt suspected of myxoedema crisis.

+ve result on U&Es?
-2

A

↓Na+ ↑creatinine

41
Q

pt suspected of myxoedema crisis.

+ve result on ABG?
-3

A

↓O2 ↑CO2 ↓pH

42
Q

pt suspected of myxoedema crisis.

+ve result on serum cortisol?

what should you assume before test result even comes back?

A

↓cortisol

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

43
Q

pt suspected of myxoedema crisis.

where do you send?

A

ITU

44
Q

main cause of death in myxoedema crisis?

A

resp failure

45
Q

pt has myxoedema crisis.

how you treat Hypothermia?

A

slow warming

46
Q

pt has myxoedema crisis.

what do you need to give IV?

  • 2 things
  • and how much
A 
IV thyroid (100-500 μg)
IV hydrocortisone (100mg)
47
Q

pt has myxoedema crisis.

what do you need to give IV?

  • 2 things
  • and how much
A 
IV thyroid (100-500 μg)
IV hydrocortisone (100mg)
48
Q

pt has myxoedema crisis.

trigger was infection.

what else do you give now?

A

antibiotics

49
Q

pt has myxoedema crisis.

what do you need to give IV?

  • 2 things
  • and how much
A 
IV thyroid (100-500 μg)
IV hydrocortisone (100mg)

Endocrinology (16 decks)

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