Thyroid emergencies: Myxedema coma and thyroid storm
Nadia Barghouthi, Jessica Perini in Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Myxedema coma consists of severe hypothyroidism usually with concomitant mental status changes. It is rarely diagnosed in pregnancy but treatment of severe hypothyroidism is imperative to prevent complications to the mother and developing fetus. Treatment consists of glucocorticoids to prevent adrenal crisis and intravenous levothyroxine. Liothyronine does not cross the placenta so its use is not recommended in pregnancy. Thyrotoxicosis leading to severe clinical symptoms can pose a significant risk to life. Although severe elevations of thyroid hormones may be noted on blood tests, most people with such lab values do not develop thyroid storm. Conversely, thyroid storm may develop in those with only mild or moderate thyroid hormone excess. For often unclear reasons, perhaps triggered by a medical event, there is a sudden worsening of the signs and symptoms commonly attributed to hyperthyroidism, leading to acute decompensation and potentially life-threatening consequences.
The Pericardium
P. Chopra, R. Ray, A. Saxena in Illustrated Textbook of Cardiovascular Pathology, 2013
Heart is encased by the pericardium which has a visceral layer closely opposed to the heart and the parietal layer. In normal states it is thin, transparent and the myocardium can be seen through it. It shows a lining of flattened to cuboidal mesothelial cells. A great deal of difficulty can be encountered in distinguishing reactive mesothelial cell from cells shed from a mesothelioma and carcinoma. A final diagnosis in most of the cases rests on a combined evaluation of histological, histochemical and immunocyto-chemical findings in addition to clinical features of the thickened pericardium. Serous effusion is accumulation of clear or straw colored fluid in the pericardial cavity. Common causes include congestive heart failure, and hypoproteinemia. Myxedema, rheumatic fever, systemic lupus erythematosis are some of the other causes. Granulomatous inflammation with areas of necrosis is seen. The granulomas are bordered by chronic inflammation.
Craniopharyngioma
Dongyou Liu in Tumors and Cancers, 2017
Craniopharyngioma is a rare, benign tumor of the sellar region that consists of two recognized histopathologic variants: adamantinomatous and papillary. The sellar region is the area around the sella turcica, which is a saddle-shaped, bony depression within the sphenoid bone at the skull base, and in which the pituitary gland is situated. Above the sellar region lies the suprasellar cistern, with several vital structures traversing the area. Craniopharyngioma has an estimated incidence of 0.5-2 cases per million per year and accounts for 2-5 percent of all primary brain tumors. Despite its slow growth, craniopharyngioma can put pressure on the brain, the optic chiasm, and the pituitary gland, leading to clinical symptoms such as headache, visual impairment, endocrine deficits, balance disorder, dry skin, fatigue, fever, hypersomnia, lethargy, myxedema, nausea, vomiting, short stature, polydipsia, polyuria, and postsurgical weight gain. Diagnosis of craniopharyngioma involves physical exam, medical history review, neurological exam, etc.
Sudden cardiac arrest as a rare presentation of myxedema coma: case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2017
Divya Salhan, Deepak Sapkota, Prakash Verma, Saroj Kandel, Omar Abdulfattah, Antony Lixon, Deribe Zwenge, Frances Schmidt
Myxedema coma is a decompensated hypothyroidism which occurs due to long-standing, undiagnosed, or untreated hypothyroidism. Untreated hypothyroidism is known to affect almost all organs including the heart. It is associated with a decrease in cardiac output, stroke volume due to decreased myocardial contractility, and an increase in systemic vascular resistance. It can cause cardiac arrhythmias and the most commonly seen conduction abnormalities are sinus bradycardia, heart block, ventricular tachycardia, and torsade de pointes. The authors report a case of an elderly man who presented with sudden cardiac arrest and myxedema coma and who was successfully revived.
A RARE CAUSE OF ASCITES: MYXOEDEMA ASCITES
Published in Acta Clinica Belgica, 2013
K Stinkens, E Vermeyen, G De Hondt
The case report describes an 88-year-old patient who presented with new-onset ascites. After excluding frequent causes of ascites, he was diagnosed with myxoedema ascites. Myxoedema ascites is rare. Analysis of ascitic fluid shows a high serum-ascites albumin gradient and a high protein level. Myxoedema ascites resolves completely after starting thyroid hormone replacement therapy.
Myxedema Coma with Cardiac Tamponade and Severe Cardiomyopathy
Published in Baylor University Medical Center Proceedings, 2015
Abdulla Majid-Moosa, Jeffrey M. Schussler, Adan Mora
Myxedema coma is an infrequent but potentially fatal complication of hypothyroidism. We present a rare case of previously undiagnosed hypothyroidism presenting in cardiogenic shock from pericardial tamponade and depressed myocardial contractility in myxedema coma. Here, we focus on cardiovascular complications associated with the condition.
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