Thyroid Emergencies Flashcards
What is Myxedema?
Another term for severely advanced hypothyroidism
Myxedema occurs secondary to what?
Secondary to infiltration of subcutaneous tissues by a hydrophilic mucopolysaccharide substance
What are the clinical features of Myxedema?
Swelling of:
- Face
- Hands
- Lower legs
- Feet
What are the diagnostic studies of Myxedema?
↑TSH
↓TH (T4)
What is the tx for Myxedema?
Levothyroxine
What are the clincial features of myxedema coma?
- Bradycardia
- Hypotension
- Reduced levels of consciousness
- Seizures
- Hypothermia
- Macroglossia, ptosis
- Hx. poor compliance or undiagnosed hypothyroidism
What is the mortality rate of myxedema coma?
Highest mortality rate, despite invasive tx
Myxedema coma almost always occurs in who and precipitated by what?
- Elderly population
- Impaired respiration
What are some examples that can impair your respiration?
- Medications: CNS Depressants: Sedatives, Anesthesia, Antidepressants
- Pneumonia
- Hypoventilation
- CHF
- MI
- GI Bleed
- CVA
- Sepsis
- Cold Exposure
What is the tx for myxedema coma?
Levothyroxine 500 ug IV Bolous
External warming if <30 C
What is Thyrotoxic Crisis or Thyroid Strom?
Rare life-threatening exacerbation of hyperthyroidism
What is the mortality rate of Thyrotoxic Crisis or Thyroid Strom if left untreated?
~ 30% d/t:
- Cardiac Failure
- Arrhythmia
- Hyperthermia
Thyrotoxic Crisis or Thyroid Strom is usually precipitated by what acute illnesses?
- CVA
- Trauma
- DKA
- Infection
- Surgery
- Radioiodine Treatment
What are the clinical features of Thyrotoxic Crisis or Thyroid Strom?
- Fever
- Vomiting
- Delirium
- Diarrhea
- Seizures/Coma
- Jaundice
What is the tx for Thyrotoxic Crisis or Thyroid Strom?
Medical Emergency get to the ER right away!!
