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Onyebuchi E Okosieme - One of the best experts on this subject based on the ideXlab platform.
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Myxedema Coma in a patient with subclinical hypothyroidism
Thyroid, 2011Co-Authors: Akhila Mallipedhi, Hamza Vali, Onyebuchi E OkosiemeAbstract:Background: Myxedema Coma is the extreme manifestation of hypothyroidism, typically seen in patients with severe biochemical hypothyroidism. Its occurrence in association with subclinical hypothyroidism is extremely unusual. We describe a patient with subclinical hypothyroidism who developed clinical manifestations of Myxedema Coma. Summary: A 47-year-old woman presented to our endocrine clinic with complaints of fatigue and biochemical findings of subclinical hypothyroidism. She was started on treatment with thyroxine (T4) but remained unwell and was later admitted to hospital with hormone profile showing persisting subclinical hypothyroidism (elevated thyrotropin and normal free T4 [FT4] and free triiodothyronine [FT3]): FT4 10.7 pmol/L (reference range 10.3–24.5), FT3 2.7 pmol/L (reference range 2.67–7.03), and thyrotropin 6.09 mU/L (reference range 0.4–4.0). She subsequently developed hypothermia (temperature 33.2°C), circulatory collapse, and Coma. Biochemical profile showed hyponatremia, elevated cr...
Yuji Tanaka - One of the best experts on this subject based on the ideXlab platform.
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clinical characteristics and outcomes of Myxedema Coma analysis of a national inpatient database in japan
Journal of Epidemiology, 2017Co-Authors: Hideo Yasunaga, Kiyohide Fushimi, Hiroki Matsui, Yuji TanakaAbstract:Abstract Background Myxedema Coma is a life-threatening and emergency presentation of hypothyroidism. However, the clinical features and outcomes of this condition have been poorly defined because of its rarity. Methods We conducted a retrospective observational study of patients diagnosed with Myxedema Coma from July 2010 through March 2013 using a national inpatient database in Japan. We investigated characteristics, comorbidities, treatments, and in-hospital mortality of patients with Myxedema Coma. Results We identified 149 patients diagnosed with Myxedema Coma out of approximately 19 million inpatients in the database. The mean (standard deviation) age was 77 (12) years, and two-thirds of the patients were female. The overall proportion of in-hospital mortality among cases was 29.5%. The number of patients was highest in the winter season. Patients treated with steroids, catecholamines, or mechanical ventilation showed higher in-hospital mortality than those without. Variations in type and dosage of thyroid hormone replacement were not associated with in-hospital mortality. The most common comorbidity was cardiovascular diseases (40.3%). The estimated incidence of Myxedema Coma was 1.08 per million people per year in Japan. Multivariable logistic regression analysis revealed that higher age and use of catecholamines (with or without steroids) were significantly associated with higher in-hospital mortality. Conclusions The present study identified the clinical characteristics and outcomes of patients with Myxedema Coma using a large-scale database. Myxedema Coma mortality was independently associated with age and severe conditions requiring treatment with catecholamines.
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a rabbit model of fatal hypothyroidism mimicking Myxedema Coma established by microscopic total thyroidectomy
Endocrine Journal, 2016Co-Authors: Masanori Fujita, Sho Ogata, Shoichi Tachibana, Yuji TanakaAbstract:: Myxedema Coma (MC) is a life-threatening endocrine crisis caused by severe hypothyroidism. However, validated diagnostic criteria and treatment guidelines for MC have not been established owing to its rarity. Therefore, a valid animal model is required to investigate the pathologic and therapeutic aspects of MC. The aim of the present study was to establish an animal model of MC induced by total thyroidectomy. We utilized 14 male New Zealand White rabbits anesthetized via intramuscular ketamine and xylazine administration. A total of 7 rabbits were completely thyroidectomized under a surgical microscope (thyroidectomized group) and the remainder underwent sham operations (control group). The animals in both groups were monitored without thyroid hormone replacement for 15 weeks. Pulse rate, blood pressure, body temperature, and electrocardiograms (ECG) were recorded and blood samples were taken from the jugular vein immediately prior to the thyroidectomy and 2 and 4 weeks after surgery. The thyroidectomized rabbits showed a marked reduction of serum thyroxine levels at 4 weeks after the surgical procedure vs. controls (0.50±0.10 vs. 3.32±0.68 μg/dL, p<0.001). Additionally, thyroidectomized rabbits exhibited several signs of hypothyroidism such as hypothermia, systolic hypotension, bradycardia, and low voltage on ECGs, compared with controls. Of the 7 rabbits with severe hypothyroidism, 6 died from 4 to 14 weeks after the thyroidectomy possibly owing to heart failure, because histopathologic examinations revealed a Myxedema heart. In summary, we have established a rabbit model of fatal hypothyroidism mimicking MC, which may facilitate pathophysiological and molecular investigations of MC and evaluations of new therapeutic interventions.
Akhila Mallipedhi - One of the best experts on this subject based on the ideXlab platform.
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Myxedema Coma in a patient with subclinical hypothyroidism
Thyroid, 2011Co-Authors: Akhila Mallipedhi, Hamza Vali, Onyebuchi E OkosiemeAbstract:Background: Myxedema Coma is the extreme manifestation of hypothyroidism, typically seen in patients with severe biochemical hypothyroidism. Its occurrence in association with subclinical hypothyroidism is extremely unusual. We describe a patient with subclinical hypothyroidism who developed clinical manifestations of Myxedema Coma. Summary: A 47-year-old woman presented to our endocrine clinic with complaints of fatigue and biochemical findings of subclinical hypothyroidism. She was started on treatment with thyroxine (T4) but remained unwell and was later admitted to hospital with hormone profile showing persisting subclinical hypothyroidism (elevated thyrotropin and normal free T4 [FT4] and free triiodothyronine [FT3]): FT4 10.7 pmol/L (reference range 10.3–24.5), FT3 2.7 pmol/L (reference range 2.67–7.03), and thyrotropin 6.09 mU/L (reference range 0.4–4.0). She subsequently developed hypothermia (temperature 33.2°C), circulatory collapse, and Coma. Biochemical profile showed hyponatremia, elevated cr...
Hamza Vali - One of the best experts on this subject based on the ideXlab platform.
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Myxedema Coma in a patient with subclinical hypothyroidism
Thyroid, 2011Co-Authors: Akhila Mallipedhi, Hamza Vali, Onyebuchi E OkosiemeAbstract:Background: Myxedema Coma is the extreme manifestation of hypothyroidism, typically seen in patients with severe biochemical hypothyroidism. Its occurrence in association with subclinical hypothyroidism is extremely unusual. We describe a patient with subclinical hypothyroidism who developed clinical manifestations of Myxedema Coma. Summary: A 47-year-old woman presented to our endocrine clinic with complaints of fatigue and biochemical findings of subclinical hypothyroidism. She was started on treatment with thyroxine (T4) but remained unwell and was later admitted to hospital with hormone profile showing persisting subclinical hypothyroidism (elevated thyrotropin and normal free T4 [FT4] and free triiodothyronine [FT3]): FT4 10.7 pmol/L (reference range 10.3–24.5), FT3 2.7 pmol/L (reference range 2.67–7.03), and thyrotropin 6.09 mU/L (reference range 0.4–4.0). She subsequently developed hypothermia (temperature 33.2°C), circulatory collapse, and Coma. Biochemical profile showed hyponatremia, elevated cr...
Lalli C.a. - One of the best experts on this subject based on the ideXlab platform.
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Myxedema Coma In A Patient With Type 1 Neurofibromatosis: Rare Association [Coma Mixedematoso Em Paciente Com Neurofibromatose Tipo 1: Associação Rara]
2015Co-Authors: Sasazawa D.t., Tsukumo D.m., Lalli C.a.Abstract:Myxedema Coma, a rare but fatal emergency, is an extreme expression of hypothyroidism. We describe a 51-year-old male patient who has discontinued hypothyroidism treatment 10 months earlier and developed lethargy, edema, and cold intolerance symptoms. He also had a previous diagnosis of neurofibromatosis. After admission, he progressed to respiratory insufficiency and Coma. The prompt recognition of the condition, thyroid hormone replacement, and management of the complications (hypoventilation, cardiogenic shock associated with swinging heart, adrenal and renal insufficiency and sepsis), resulted in a favorable evolution.579743747Kwaku, M.P., Burman, K.D., Myxedema Coma (2007) J Intensive Care Med, 22, pp. 224-231Wartofsky, L., Myxedema Coma (2000) The Thyroid: A Fundamental and Clinical Text, p. 843. , Braverman LE, Utiger RD (eds.). Philadelphia Lippincott: Williams & WilkinsDutta, P., Bhansali, A., Masoodi, S., Bhadada, S., Sharma, N., Rajput, R., Predictors of outcome in Myxedema Coma: A study from a tertiary care centre (2008) Critical Care, 12, pp. S1Rodríguez, I., Fluiters, E., Pérez-Méndez, L.F., Luna, R., Páramo, C., García-Mayor, R.V., Factors associated with mortality of patients with myxoedema Coma: Prospective study in 11 cases treated in a single institution (2004) J Endocrinol, 180, pp. 347-350Kearney, T., Dang, C., Diabetic and endocrine emergencies (2007) Postgrad Med J, 83, pp. 79-86Danilovic, D.L.S., Almeida, M.Q., Neto, R.A.B., Martins, H., Coma Mixedematoso (2012) Emergências Clinicas Abordagem Prática, pp. 974-980. , 7th Ed. Barueri: ManoleSantiago, R., Rashkin, M.C., Lithium toxicity and Myxedema Coma in an elderly woman (1990) J Emerg Med, 8, p. 63Park, C.W., Shin, Y.S., Ahn, S.J., Kim, S.Y., Choi, E.J., Chang, Y.S., Thyroxine treatment induces upregulation of renin-angiotensin-aldosterone system due to decreasing effective plasma volume in patients with primary myxoedema (2001) Nephrol Dial Transplant, 6, pp. 1799-1806Klubo-Gwieedzinska, J., Wartofsky, L., Thyroid emergencies (2012) Med Clin N Am, 96, pp. 385-403Villabona, C., Sahun, M., Roca, M., Mora, J., Gomez, N., Gomez, J.M., Blood volumes and renal function in overt and subclinical primary hypothyroidism (1999) Am J Med Sci, 318, p. 27280Iwasaki, Y., Oiso, Y., Yamauchi, K., Osmoregulation of plasma vasopressin in Myxedema (1990) J Clin Endocrinol Metab, 70, pp. 534-539Barker, D., Wright, E., Nguyen, K., Cannon, L., Fain, P., Goldgar, D., Gene for von Recklinghausen neurofbromatosis is in the pericentromeric region of chromosome 1 7 (1987) Science, 236, pp. 1100-1102Abbas, A., Lichtman, A.H., Disease caused by immune responses: Hipersensitivity and autoimmunity (2005) Cellular and Molecular Immunology, pp. 411-431. , Abbas A, Lichtman AH, eds., 5th ed. Philadelphia: SaundersYalcin, B., Tamer, E., Gür, G., Oztas, P., Polat, M.U., Alli, N., Neurofibroma-tosis 1/Noonan syndrome associated with Hashimoto's thyroidi-tis and vitiligo (2006) Acta Derm Venereol, 86, pp. 80-81Nanda, A., Autoimmune diseases associated with neurofibromato-sis type 1 (2008) Ped Dermatology, 25 (3), pp. 392-393Mackerrow, S.D., Osborn, L.A., Levy, H., Eaton, R.P., Economou, P., Myxedema-associated cardiogenic shock treated with intravenous triiodothyronine (1992) Ann Intern Med, 117, pp. 1014-101
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Myxedema Coma In A Patient With Type 1 Neurofibromatosis: Rare Association [Coma Mixedematoso Em Paciente Com Neurofibromatose Tipo 1: Associação Rara]
2015Co-Authors: Sasazawa D.t., Tsukumo D.m., Lalli C.a.Abstract:Myxedema Coma, a rare but fatal emergency, is an extreme expression of hypothyroidism. We describe a 51-year-old male patient who has discontinued hypothyroidism treatment 10 months earlier and developed lethargy, edema, and cold intolerance symptoms. He also had a previous diagnosis of neurofibromatosis. After admission, he progressed to respiratory insufficiency and Coma. The prompt recognition of the condition, thyroid hormone replacement, and management of the complications (hypoventilation, cardiogenic shock associated with swinging heart, adrenal and renal insufficiency and sepsis), resulted in a favorable evolution
