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Thyroid emergencies: Myxedema coma and thyroid storm
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Dushyanthy Arasaratnam, Nadia Barghouthi, Jessica Perini, Robert Weingold
Hypotension and shock with a concomitant reduction in blood volume of up to 20% can occur with myxedema coma.3 This has implications in pregnancy where the total blood volume peaks at 40% greater than baseline and smaller increases in maternal plasma blood volume are associated with intrauterine growth restriction (IUGR) and poor fetal outcomes.7 In myxedema, the increase in maternal red cell mass typically seen in pregnancy is blunted due to a reduction in erythropoietin production, leading to a decline in red cell production and fall in hematocrit of approximately 30%.3,7
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Thyroid disorders: Hypothyroidism/myxedema coma: It may be precipitated by cold, infection, or abrupt discontinuation of thyroid replacement hormone.Clinical signs include low body temperature, coarse facies, obesity, bradycardia, nonpitting edema, and delayed relaxation of tendon reflexes. Myxedema coma is a life-threatening severe expression of hypothyroidism.
Endocrine emergencies with skin manifestations
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Hypothyroidism can affect all organ systems, and the manifestations depend on the degree of hormone deficiency. A rare, life-threatening condition encountered in long-standing untreated hypothyroidism is myxedema coma. However, most patients are not in a coma, and hence, myxedema crisis may be the apt term. There is decompensation of various organs due to severe hypothyroidism. The clinical signs include altered mental status, hypothermia, bradycardia, hypoventilation, seizures, severe hypotension, and shock. There is usually a precipitating cause such as exposure to cold, infection, trauma, and certain drugs, and mortality remains high despite treatment [10].
CAR-T and checkpoint inhibitors: toxicities and antidotes in the emergency department
Published in Clinical Toxicology, 2021
Hypophysitis, or inflammation of the pituitary gland with associated hormone abnormalities, often presents with an unusual or persistent headache pattern that may be associated with non-specific symptoms such as fatigue, blurry vision, and anorexia. It is associated with Ipilimumab use, concurrent central hypothyroidism and adrenal insufficiency [16,49,50]. In addition to routine laboratory testing, diagnostic approach should include checking concentrations of electrolytes, morning cortisol, adrenocorticotropic hormone, thyroid-stimulating hormone, free thyroxine, luteinizing hormone, follicle-stimulating hormone and testosterone (for males)/estrogen (for females). Magnetic resonance imaging (MRI) of the brain with and without contrast with pituitary cuts should be obtained in patients with multiple endocrine abnormalities or severe headache with vision changes [16]. Once the diagnosis is made, high dose glucocorticoids are indicated for treatment, similar to other irAEs. Other conditions such as thyroid storm, myxedema coma, DKA, and adrenal crisis are treated in the usual fashion [16].
Is auditory brainstem response a prognostic factor in patients with sudden sensorineural hearing loss?
Published in Acta Oto-Laryngologica, 2019
Hye-Jeong Heo, Chul-Hee Choi, Sung Hwa Hong, Sihyung Kang, Myung Gu Kim, Young-Soo Chang
It is known that clinical manifestations, such as mental status, bradycardia, hypothermia, poor short-term memory, peripheral neuropathy, entrapment neuropathy, and myxedema coma, are associated with clinical hypothyroidism. The frequency and severity of peripheral nerve dysfunction in hypothyroidism depends on the severity and duration of the thyroid hormone deficiency [17]. The strength-duration properties of the peripheral nerves could be improved following hormone replacement therapy in hypothyroid patients, which suggests a strong association between nerve dysfunction and thyroid hormone levels [18]. However, the exact pathophysiological changes following thyroid hormone levels are not fully elucidated. One proposed pathophysiology of nerve dysfunction in hypothyroidism suggests that a hormonal imbalance can affect segmental demyelination of Schwann cells. In addition, other researchers suggest that lower thyroid hormone levels lead to a decrease in cell energy production, compromising microcirculation and consequently the metabolism and oxygenation of the involved organ [11]. Thyroid hormones are also known to control protein synthesis and myelin production in the central auditory pathway. In addition, T4 also acts as a neurotransmitter in the central nervous system. Thus, it can be speculated that lower thyroid hormone levels can affect the cochlea, the central auditory pathway, and the retrocochlear region [6].
The continuum of care of anticancer treatment-induced hypothyroidism in patients with solid non-thyroid tumors: time for an intimate collaboration between oncologists and endocrinologists
Published in Expert Review of Clinical Pharmacology, 2022
Maria V. Deligiorgi, Dimitrios T. Trafalis
The signs and symptoms of hypothyroidism – depicted in Table 2 – are neither sensitive nor specific [40], hampering the clinical diagnosis. Especially in cancer patients, the clinical manifestations of hypothyroidism may remain undetected or be misattributed to other conditions, principally to patient’s comorbidities, toxicities of anticancer treatments other than thyroid toxicities, or cancer progression. Undiagnosed hypothyroidism may lead to dose reductions or cessation of potentially life-saving anticancer therapies, subvert the quality of life, result in life-threatening myxedema coma, or increase the toxicity of anticancer drugs due to alterations in their kinetics and clearance [23].