1
|
Yafit D, Carmel-Neiderman NN, Levy N, Abergel A, Niv A, Yanko-Arzi R, Zaretski A, Wengier A, Fliss DM, Horowitz G. Postoperative myxedema coma in patients undergoing major surgery: Case series. Auris Nasus Larynx 2018; 46:605-608. [PMID: 30454972 DOI: 10.1016/j.anl.2018.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/22/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Myxedema coma is a serious complication of hypothyroidism that can be precipitated by major surgery. It is extremely rare, with only a few reports in the literature. This study aims to present a relatively large case series of post-surgical myxedema coma and to analyze medical and surgical risk factors. METHODS Analysis of the patients' surgical records and medical charts. RESULTS Four patients developed postoperative myxedema coma and were evaluated for risk factors. Three had known hypothyroidism. Two had undergone large head and neck composite resections necessitating a free flap repair for malignant disease. One had undergone coronary artery bypass graft for ischemic heart disease, and another had undergone endoscopic cholecystectomy for complicated cholecystitis. All four patients required prolonged hospitalization, including treatment in the intensive care unit. One patient had undergone full cardiopulmonary resuscitation directly related to the myxedema coma state. CONCLUSION We present a series of four patients who developed myxedema coma following major surgery. We recommend that patients with known hypothyroidism who are scheduled for major surgery should be tested for thyroid function status and assessed for postoperative risk of hypothyroidism. Those who develop complications following major surgery, should be immediately tested for thyroid function to rule out myxedema coma.
Collapse
Affiliation(s)
- Daniel Yafit
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Narin Nard Carmel-Neiderman
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Levy
- Department of Anesthesiology, Pain and Critical Care, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avrham Abergel
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Niv
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Yanko-Arzi
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arik Zaretski
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Wengier
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
2
|
Ugalde I, Bello Segura M, Oneto S, Ciment A. The forgotten electrolyte, when hypercalcaemia manifest as gait instability and altered mental status. BMJ Case Rep 2018; 2018:bcr-2017-224089. [PMID: 29507034 DOI: 10.1136/bcr-2017-224089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An altered mental status presents a diagnostic challenge for many clinicians. Described here is a case of primary hyperparathyroidism not initially suspected until after a thorough neurological and infectious cause were excluded. A 60-year-old woman presented with altered mental status and gait instability. Her family noticed progressive gait instability and mood swings for the past 4 months. Initial imaging and laboratory values were unable to explain her symptoms. On transfer out of the intensive care unit, her corrected calcium was found to be 13.3 mg/dL with an elevated parathyroid hormone. Her hypercalcaemia was refractory to medical management. Ultrasound found a 2 cm nodule, which was surgically removed and found to be a parathyroid adenoma. Her calcium normalised and neurological deficits subsided. Hypercalcaemia can lead to a constellation of symptoms that include the classical 'stones, bones, abdominal moans and psychic groans' and electrolyte derangements should be considered in the differential of altered mental status.
Collapse
Affiliation(s)
- Israel Ugalde
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Manuel Bello Segura
- Department of Endocrinology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sabrina Oneto
- Department of Pathology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Ari Ciment
- Department of Pulmonary, Mount Sinai Hospital, Miami Beach, Florida, USA
| |
Collapse
|
3
|
Affiliation(s)
- J Witczak
- From the Aneurin Bevan Health Board, Department of Diabetes and Endocrinology, Royal Gwent Hospital, Cardiff Road, Newport, Gwent, NP20 2UB, UK
| | - O Williams
- From the Aneurin Bevan Health Board, Department of Diabetes and Endocrinology, Royal Gwent Hospital, Cardiff Road, Newport, Gwent, NP20 2UB, UK
| | - T Shekaraiah
- From the Aneurin Bevan Health Board, Department of Diabetes and Endocrinology, Royal Gwent Hospital, Cardiff Road, Newport, Gwent, NP20 2UB, UK
| | - K Obuobie
- From the Aneurin Bevan Health Board, Department of Diabetes and Endocrinology, Royal Gwent Hospital, Cardiff Road, Newport, Gwent, NP20 2UB, UK
| |
Collapse
|
4
|
Yu J. Endocrine disorders and the neurologic manifestations. Ann Pediatr Endocrinol Metab 2014; 19:184-90. [PMID: 25654063 PMCID: PMC4316409 DOI: 10.6065/apem.2014.19.4.184] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 12/30/2014] [Indexed: 11/30/2022] Open
Abstract
The nervous system and the endocrine system are closely interrelated and both involved intimately in maintaining homeostasis. Endocrine dysfunctions may lead to various neurologic manifestations such as headache, myopathy, and acute encephalopathy including coma. It is important to recognize the neurologic signs and symptoms caused by the endocrine disorders while managing endocrine disorders. This article provides an overview of the neurologic manifestations found in various endocrine disorders that affect pediatric patients. It is valuable to think about 'endocrine disorder' as a cause of the neurologic manifestations. Early diagnosis and treatment of hormonal imbalance can rapidly relieve the neurologic symptoms. Better understanding of the interaction between the endocrine system and the nervous system, combined with the knowledge about the pathophysiology of the neurologic manifestations presented in the endocrine disorders might allow earlier diagnosis and better treatment of the endocrine disorders.
Collapse
Affiliation(s)
- Jeesuk Yu
- Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|