 Print page |
 Email page |
Severe mental impairment and poor physiologic status predict mortality in patients with myxedema coma
The background of the study. Patients
with myxedema coma have impaired consciousness, and many have complicating
illnesses. This study described the clinical findings and evaluated
the response to thyroxine (T4) therapy, given in two different ways,
in patients with myxedema coma.
How the study was done. Eleven patients (10 women, 1 man; mean age, 68 years) with myxedema coma were treated at a single hospital in Spain during a 17-year period. Myxedema coma was defined as impaired mental status, low body temperature (<35.0ºC), the presence of a precipitating illness (urinary infection, respiratory infection), and a low serum free T4 concentration. Eight patients had high serum thyrotropin (TSH) concentrations, and three did not (all three had a pituitary tumor). The patients were randomly assigned to receive a single intravenous dose of 500 µg of T4 followed by daily intravenous doses of 100 µg, or daily intravenous doses of 100 µg, until they could take T4 orally.
The results of the study. Seven patients were obtunded, and four were comatose. Their heart rates ranged from 38 to 144 beats per minute, respiratory rates from 10 to 25 per minute, and rectal temperature from 33.6 to 35.0ºC. The Glasgow coma scores ranged from 3 to 14 (low is more abnormal), and the APACHE II scores from 14 to 34 (high is more abnormal).
Four of the 11 patients (36 percent) died 4 to 15 days after hospitalization. Three of the four patients who were in coma on admission, but only one of the seven who were obtunded died. The initial Glasgow coma scores were lower and the APACHE II scores were higher in the patients who died. Among the six patients treated with the high initial dose of T4, only one (17 percent) died, as compared with three of the five patients (60 percent) who received the low dose.
The conclusions of the study. Among patients with myxedema coma, the level of consciousness and degree of impairment are the most important predictors of survival, and high-dose T4 therapy may be more effective.
The original article.Rodriguez
I, Fluiters E, Perez-Mendez LF, Luna R, Paramo C, Garcia-Mayor RV.
Factors associated with mortality of patients with myxoedema coma:
prospective study in 11 cases treated at a single institution. J
Endocrinol 2004;180:347-50.
Next Article: Thyroxine plus triiodothyronine and thyroxine
alone have similar effects in patients with hypothyroidism
|
||
| Thyroid Digest Index | | | July 2004 Thyroid Digest |
