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Treatment should be initiated on the basis of clinical suspicion without waiting for laboratory results. Important clues to the possible presence of myxedema coma in a poorly responsive patient are the presence of a thyroidectomy scar or a history of radioiodine therapy or hypothyroidism.
The most important elements in treatment of myxedema coma are early recognition, presumptive thyroid hormone replacement, hydrocortisone and appropriate supportive care.
treatment for decompensated hypothyroidism: IV dextrose if hypoglycemic. Steroid: 100 mg IV hydrocortisone q8hr (alternative: 60 mg IV methylprednisolone daily). IV levothyroxine (T4): Loading dose ~250 mcg IV. Antibiotics: consider empiric therapy if sepsis is possible. Liothyronine (T3): consider in the sickest patients.
Early recognition, a thorough history, physical exam, and early treatment are paramount in managing myxedema coma. This activity reviews the cause, pathophysiology, and presentation of myxedema and highlights the role of the interprofessional team in management.
Recommendation 21 of the ATA Guidelines for the treatment of hypothyroidism (Jonklaas et al. 2014) deals with the management of myxedema coma. It favors an initial loading dose of levothyroxine (200-400 μg intravenously) and intravenous glucocorticoid administration (strong recommendation, low-quality evidence).
Getting diagnosed and treated early can significantly reduce your risk of having myxedema coma. If you or someone you know is having symptoms that could point to myxedema coma, get medical help immediately.
Diagnosis. Complications. Treatment. Outlook. Myxedema is a severe form of hypothyroidism characterized by swelling and thickening of your skin. More severe symptoms, such as hypothermia or...