Legions of Presentations of Myxedema Coma

A Case Series from a Tertiary Hospital in India

  • Nirmalya Roy KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata
  • Anirban Majumder KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata https://orcid.org/0000-0001-6937-8675
  • Debmalya Sanyal KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata https://orcid.org/0000-0002-8186-3697
  • Soumyabrata Roy Chaudhuri KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata
  • Suman Sarkar KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata https://orcid.org/0000-0002-0268-2119
  • Ankan Pathak KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata
Keywords: myxedema coma, presentations, outcomes, case reports

Abstract

Myxedema coma is associated with decreased mental status and hyponatremia among patients with diagnosed or undiagnosed hypothyroidism. The diagnosis is challenging in the absence of universally accepted diagnostic criteria, but should be considered as a differential even in cases with competing established diagnoses. All patients should receive intensive care level treatment. Even with optimal treatment, mortality is very high.

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Author Biographies

Nirmalya Roy, KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata

Professor, Department of Internal Medicine

Anirban Majumder, KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata
Professor, Department of Endocrinology

 

Debmalya Sanyal, KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata

Professor, Department of Internal Medicine

Soumyabrata Roy Chaudhuri, KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata

Registrar, Department of Endocrinology

Suman Sarkar, KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata

Resident, Department of Internal Medicine

Ankan Pathak, KPC Medical College and Hospital, West Bengal University of Health Sciences, Kolkata

Resident, Department of Internal Medicine

References

Mathew V, Misgar RA, Ghosh S, et al. Myxedema coma: A new look into an old crisis. J Thyroid Res. 2011;2011:493462. https://www.ncbi.nlm.nih.gov/pubmed/21941682. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3175396. https://doi.org/10.4061/2011/493462.

Murthy TA, Rangappa P, Jacob IPR, Janakiraman R, Rao K. Myxoedema coma in adults: Experience from a tertiary referral hospital intensive care unit. Indian J Anaesth. 2015;59(5):315-7. https://www.ncbi.nlm.nih.gov/pubmed/26019358. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445155. https://doi.org/10.4103/0019-5049.156889.

Mylliemngap B, Swain S, Vyas S, Kumar P. Myxedema coma, pancytopenia, and hypocoagulopathy: A rare presentation of Sheehan's syndrome. Indian J Endocrinol Metab. 2019;23(2):268-9. https://www.ncbi.nlm.nih.gov/pubmed/31161117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540897. https://doi.org/10.4103/ijem.IJEM_120_19.

Baduni N, Sinha SK, Sanwal MK. Perioperative management of a patient with myxedema coma and septicemic shock. Indian J Crit Care Med. 2012;16(4):228-30. https://www.ncbi.nlm.nih.gov/pubmed/23559735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610460. https://doi.org/10.4103/0972-5229.106510.

Dutta P, Bhansali A, Masoodi SR, Bhadada S, Sharma N, Rajput R. Predictors of outcome in myxoedema coma: A study from a tertiary care centre. Crit Care. 2008;12(1):R1. https://www.ncbi.nlm.nih.gov/pubmed/18173846. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374608. https://doi.org/10.1186/cc6211.

Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. J Epidemiol. 2017;27(3):117-22.

https://www.ncbi.nlm.nih.gov/pubmed/28142035. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350620. https://doi.org/10.1016/j.je.2016.04.002.

Popoveniuc G, Chandra T, Sud A, et al. A diagnostic scoring system for myxedema coma. Endocr Pract. 2014;20(8):808-17. https://www.ncbi.nlm.nih.gov/pubmed/24518183. https://doi.org/10.4158/EP13460.OR.

Wall CR. Myxedema coma: Diagnosis and treatment. Am Fam Physician. 2000;62(11):2485-90. https://www.ncbi.nlm.nih.gov/pubmed/11130234.

Nicoloff JT, LoPresti JS. Myxedema coma. A form of decompensated hypothyroidism. Endocrinol Metab Clin North Am. 1993;22(2):279-90. https://www.ncbi.nlm.nih.gov/pubmed/8325287.

Rodrigo C, Gamakaranage CS, Epa DS, Gnanathasan A, Rajapakse S. Hypothyroidism causing paralytic ileus and acute kidney injury - case report. Thyroid Res. 2011;4(1):7. https://www.ncbi.nlm.nih.gov/pubmed/21303532. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041782. https://doi.org/10.1186/1756-6614-4-7.

Abuzaid AS, Birch N. The controversies of hyponatraemia in hypothyroidism: Weighing the evidence. Sultan Qaboos Univ Med J. 2015;15(2):e207-12. https://www.ncbi.nlm.nih.gov/pubmed/26052453. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450783.

Zwillich CW, Pierson DJ, Hofeldt FD, Lufkin EG, Weil JV. Ventilatory control in myxedema and hypothyroidism. N Engl J Med. 1975;292(13):662-5. https://www.ncbi.nlm.nih.gov/pubmed/1113761. https://doi.org/10.1056/NEJM197503272921302.

Silva EI, Landsberg L. “Catecholamines and the sympathoadrenal system in hypothyroidism.” In: The Thyroid. LE Braverman, RD Utiger, eds. Philadelphia: J.B. Lippincott Co., 1992.

Schenck JB, Rizvi AA, Lin T. Severe primary hypothyroidism manifesting with torsades de pointes. Am J Med Sci. 2006;331(3):154-6. https://www.ncbi.nlm.nih.gov/pubmed/16538077. https://doi.org/10.1097/00000441-200603000-00008.

Iwasaki Y, Oiso Y, Yamauchi K, et al. Osmoregulation of plasma vasopressin in myxedema. J Clin Endocrinol Metab. 1990;70(2):534-9. https://www.ncbi.nlm.nih.gov/pubmed/2298864. https://doi.org/10.1210/jcem-70-2-534.

Published
2020-11-29
How to Cite
Roy, N., Majumder, A., Sanyal, D., Roy Chaudhuri, S., Sarkar, S., & Pathak, A. (2020). Legions of Presentations of Myxedema Coma: A Case Series from a Tertiary Hospital in India. Journal of the ASEAN Federation of Endocrine Societies, 35(2), 233-237. https://doi.org/10.15605/jafes.035.02.12
Section
Case Series