<\/span><\/h2>\nHypothermia, weight gain, constipation<\/p>\n
5% of carpal tunnel is hypothyroid<\/p>\n
500 mg T4 orally or IV, give stress does of steroids as well.<\/p>\n
Myxedema Coma<\/p>\n
Rx:<\/p>\n
Supportive Care<\/p>\n
Levothyroxine 300 to 500 ug IVPB then 50 to 100 ug IV OD<\/p>\n
T3 25 ug IV\/PO Q8<\/p>\n
Consider Hydrocortisone 100 mg IV Q8 before thyroid replacement (Draw Cortisol first if possible)<\/p>\n
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Thyroid hormone \u0097 The optimal mode of thyroid hormone therapy in patients with myxedema coma is controversial, largely because the condition is so rare that there are no clinical trials comparing the efficacy of different treatment regimens. While increasing serum thyroid hormone concentrations rapidly carries some risk of precipitating myocardial infarction or atrial arrhythmias, this risk must be accepted because of the high mortality of untreated myxedema coma. There is disagreement about the preferred thyroid hormone regimen, but both very high and very low doses seem less effective than intermediate doses [14]. Some experts favor administration of triiodothyronine (T3), because its biologic activity is greater and its onset of action is more rapid than T4. An additional consideration is that the conversion of T4 to T3 is impaired due to both hypothyroidism and any concurrent nonthyroidal illness. Proper dosing is important. High serum T3 concentrations during treatment have been correlated with mortality [13]. Others prefer T4, which should be given intravenously because gastrointestinal absorption may be impaired [15]. The first dose should be large: 200 to 400 mcg (0.2 to 0.4 mg), with the exact dose being dependent upon the patient’s weight and age and the likelihood of complications such as myocardial infarction or an arrhythmia. In one randomized trial of 11 patients, those who received a 500 mcg loading dose followed by 100 mcg daily had a lower mortality than those treated with 100 mcg daily without a loading dose; however, the difference did not reach statistical significance [16]. Thus, the dose should be reduced in lighter and older patients and those at risk for cardiac complications. Daily doses of 50 to 100 mcg are given thereafter, initially intravenously and, when feasible, orally. (See “Treatment of hypothyroidism” for a discussion of chronic therapy). We prefer to give both hormones [17]. T4 is given in a loading dose of 200 to 300 mcg followed by 50 mcg daily. T3 is given simultaneously in a dose of 5 to 20 mcg, followed by 2.5 to 10 mcg every eight hours depending upon the patient’s age and coexistent cardiac risk factors. T3 is continued until there is clinical improvement and the patient is stable. Supportive measures \u0097 Supportive measures are extremely important in the treatment of patients with myxedema coma and, in the first day or so, may make the difference between survival and death. These measures include treatment in an intensive care unit, mechanical ventilation if necessary, judicious administration of intravenous fluids including electrolytes and glucose, correction of hypothermia, and treatment of any underlying infection. Dilute fluids should be avoided in hyponatremic patients to prevent a further reduction in the plasma sodium concentration. Hypotension, if present and not caused by volume depletion, will be corrected by thyroid hormone therapy over a period of hours to days. Severe hypotension that does not respond to fluids should be treated with a vasopressor drug until the T4 has had time to act. Passive rewarming with a heating blanket is preferred for correction of hypothermia. Active rewarming carries a risk of vasodilatation and worsening hypotension. As with any critically ill, comatose patient, empiric administration of antibiotics should be considered until appropriate cultures are proven negative.<\/p>\n
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Myxedema almost always has a cpk>500<\/p>\n
winter months<\/p>\n
sed\/hyp and psych drugs<\/p>\n
amiodarone<\/p>\n
diuretics<\/p>\n
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<\/a><\/p>\n <\/p>\n
labs to send tsh, free t4, total t4delayed dtr, low wbc with lymphocytic predominencethey will all have altered mental status of some ilk if they are myxedematous, better to call it decompensated hypothyroidismgive 500 mcg of T4mostly anemicfluid downgive hydrocortisone firsthyponatremiagive betablockers for thyroid paralysis<\/p>\n
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<\/span>Euthyroid Sick Syndrome<\/span><\/h3>\nthyroid function abnormality from illness or stress without underlying thyroid disease.<\/p>\n
Probably from cytokine interactions<\/p>\n
Initially low levels of T4 and T3 with normal TSH, eventually TSH will decline as well<\/p>\n
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Thyroid Disorders - Crashing Patient<\/title>\n\n\n\n\t\n\t\n\t\n