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Myxedema coma is an extreme or decompensated form of hypothyroidism and while uncommon, is potentially lethal. [1] [2] [3] A person may have laboratory values identical to a "normal" hypothyroid state, but a stressful event (such as an infection, myocardial infarction, or stroke) precipitates the myxedema coma state, usually in the elderly.
Potential complications include thyroid lymphoma. [2] Further complications of hypothyroidism can include high cholesterol, heart disease, heart failure, high blood pressure, myxedema, and potential problems in pregnancy. [1] Hashimoto's thyroiditis is thought to be due to a combination of genetic and environmental factors.
Thyroidectomy is a common surgical procedure that has several potential complications or sequelae including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction due to bilateral vocal cord paralysis.
In areas where iodine-deficiency is not found, the most common type of hypothyroidism is an autoimmune subtype called Hashimoto's thyroiditis, with a prevalence of 1-2%. [40] As for hyperthyroidism, Graves' disease , another autoimmune condition, is the most common type with a prevalence of 0.5% in males and 3% in females. [ 41 ]
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[8] [9] Hashimoto's thyroiditis is the most common cause of hypothyroidism in countries with sufficient dietary iodine. [3] Less common causes include previous treatment with radioactive iodine, injury to the hypothalamus or the anterior pituitary gland, certain medications, a lack of a functioning thyroid at birth, or previous thyroid surgery.
Propranolol at high doses is a common first-line treatment, as it reduces peripheral conversion of T4 to T3, which is the more active form of thyroid hormone. [ 26 ] [ 21 ] Non-selective beta blockers have been suggested to be beneficial due to their inhibitory effects on peripheral deiodinases.
Surgery (thyroidectomy to remove the whole thyroid or a part of it) is not extensively used because most common forms of hyperthyroidism are quite effectively treated by the radioactive iodine method, and because there is a risk of also removing the parathyroid glands, and of cutting the recurrent laryngeal nerve, making swallowing difficult ...