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Myxoedema coma - Generics
Myxedema coma is a rare but life-threatening complication of severe hypothyroidism. It is characterized by decreased mental status, hypothermia, hypotension, hypoventilation, and other systemic manifestations. The condition typically affects patients with long-standing and untreated hypothyroidism and can be precipitated by a variety of stressors, including infections, medications, and trauma.
The pathophysiology of myxedema coma is complex and not fully understood. Severe hypothyroidism leads to decreased metabolism, reduced oxygen consumption, and impaired thermoregulation, which can result in multisystem organ failure. The accumulation of glycosaminoglycans in the skin and other tissues, known as myxedema, is a hallmark of the condition.
The diagnosis of myxedema coma can be challenging and requires a high index of suspicion. Clinical features such as decreased mental status, hypothermia, and bradycardia are often present. Laboratory findings may include hyponatremia, hypercapnia, and elevated creatinine kinase levels. Thyroid function tests may reveal severe hypothyroidism, with low levels of free T4 and elevated levels of thyroid-stimulating hormone.
The treatment of myxedema coma is focused on reversing the hypothyroid state, providing supportive care, and managing any precipitating factors. Intravenous thyroid hormone replacement with triiodothyronine (T3) or thyroxine (T4) is the cornerstone of therapy. Supportive care measures include mechanical ventilation, hemodynamic support, and correction of electrolyte abnormalities. Infection, if present, should be aggressively treated.
The prognosis of myxedema coma is variable and depends on the severity of the underlying hypothyroidism, the presence of precipitating factors, and the promptness and effectiveness of treatment. Mortality rates have been reported to range from 20% to 60%, with higher rates in patients with more severe illness and those who develop complications such as sepsis or multiorgan failure.
In conclusion, myxedema coma is a rare but potentially fatal complication of severe hypothyroidism. The diagnosis can be challenging and requires a high index of suspicion. Prompt recognition and treatment are essential for improving outcomes in these patients.
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Myxoedema coma, মাইক্সোয়েডা কোমা
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