USMLE/COMLEX - Step 2 - Myxedema Coma

USMLE/COMLEX - Step 2 - Myxedema Coma Myxedema coma is caused by severe hypothyroidism, which leads to decreased thyroid hormone production, accumulation of mucopolysaccharides, altered electrolyte balance, reduced cardiac output, and impaired central nervous system function. These interconnected processes result in edema, thickening of tissues, cardiovascular complications, confusion, lethargy, and coma. Mental status changes Edema and thickening of the skin Weight gain and fluid retention Constipation Decreased level of consciousness Hypothermia Bradycardia Hypotension Respiratory failure Edema Hyponatremia Hypoglycemia Hypercapnia Elevated creatine kinase levels Thyroid function tests Arterial blood gas analysis Electrolyte tests Complete blood count Imaging studies Creatine kinase levels ECG Myxedema coma is a medical emergency that requires prompt treatment. The management of myxedema coma typically involves the following measures: 1. Airway management: ensuring adequate oxygenation and ventilation by administering oxygen and providing mechanical ventilation, if necessary. 2. Thyroid hormone replacement therapy: intravenous administration of levothyroxine (T4) and triiodothyronine (T3) to restore thyroid hormone levels to normal. 3. Correction of electrolyte imbalances: administration of intravenous fluids and electrolytes to correct any imbalances, such as hyponatremia or hypoglycemia. 4. Supportive care: providing supportive care to manage complications, such as respiratory failure, cardiovascular instability, and infection. 5. Identifying and treating underlying triggers: identifying and treating any underlying triggers that may have precipitated myxedema coma, such as infection, medication changes, or discontinuation of thyroid hormone replacement therapy. 6. Monitoring and follow-up: closely monitoring the patient's vital signs, electrolyte levels, and response to treatment, and providing follow-up care to ensure continued hypothyroidism management.