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Alnaeem MM, Suleiman KH, Mansour NH, Alwahsh BS, Nashwan AJ. Amiodarone-Induced Myxedema Coma in Elderly Patients: A Systematic Review of Case Reports. Cureus 2023; 15:e40893. [PMID: 37492810 PMCID: PMC10364664 DOI: 10.7759/cureus.40893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/27/2023] Open
Abstract
This systematic review aimed to explore whether elderly patients administered amiodarone were susceptible to developing myxedema coma. Utilizing the Cochrane guidelines, a comprehensive review of databases such as Medline (PubMed), Science Direct, CINAHL Cochrane, and Google Scholar was undertaken to examine case reports on amiodarone-induced myxedema coma. Following stringent criteria for inclusion, 12 pertinent case reports were identified. These findings suggested a high probability of myxedema coma development in patients who had been administered amiodarone. Specifically, patients who received an oral dosage of 100-200 mg of amiodarone were reported to have developed bradycardia and hypothermia alongside elevated thyroid-stimulating hormone (TSH) levels. Upon diagnosis, the majority of patients were treated with a regimen of levothyroxine and hydrocortisone medication. Despite the myriad potential causes of myxedema coma complicating the diagnosis, it was found that through a combination of clinical symptoms and serum TSH measurements, a confirmed diagnosis could be reached. Furthermore, it was observed that amiodarone-induced myxedema coma responded favorably to treatment with levothyroxine and glucocorticoids.
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Affiliation(s)
| | | | - Nadeen H Mansour
- School of Nursing, Al-Zaytoonah University of Jordan, Amman, JOR
| | - Bayan S Alwahsh
- School of Nursing, Al-Zaytoonah University of Jordan, Amman, JOR
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Ito H, Fukuda K, Ashida K, Nagayama A, Sako T, Mizuochi K, Kabashima M, Yoshinobu S, Iwata S, Hasuzawa N, Hayashi S, Akashi T, Nomura M. Case Report: Myxedema Coma Caused by Immunoglobulin A Vasculitis in a Patient With Severe Hypothyroidism. Front Immunol 2022; 13:838739. [PMID: 35251034 PMCID: PMC8895252 DOI: 10.3389/fimmu.2022.838739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Myxedema coma is a critical disorder with high mortality rates. Disruption of the compensatory mechanism for severe and long-term hypothyroidism by various causes leads to critical conditions, including hypothermia, respiratory failure, circulatory failure, and central nervous system dysfunction. Infectious diseases, stroke, myocardial infarction, sedative drugs, and cold exposure are considered the main triggers for myxedema coma. A 59-year-old Japanese woman presented with bilateral painful purpura on her lower legs. She was diagnosed with coexisting immunoglobulin A (IgA) vasculitis and severe IgA vasculitis with nephritis and was consequently treated with intravenous methylprednisolone (125 mg/day). However, she rapidly developed multiple organ failure due to the exacerbation of severe hypothyroidism, i.e., myxedema. Her condition improved significantly following oral administration of prednisolone along with thyroxine. There was a delayed increase in the serum free triiodothyronine level, while the serum free thyroxine level was quickly restored to normal. Rapid deterioration of the patient’s condition after admission led us to diagnose her as having myxedema coma triggered by IgA vasculitis. Hence, clinicians should be aware of the risks of dynamic exacerbations in patients with hypothyroidism. Furthermore, our study suggested that combination therapy with thyroxine and liothyronine might prove effective for patients with myxedema coma, especially for those who require high-dose glucocorticoid administration.
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Affiliation(s)
- Hiroshi Ito
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
- Department of Diabetology, Shimada Hospital, Ogori, Japan
| | - Kenzo Fukuda
- Department of Diabetology, Shimada Hospital, Ogori, Japan
- Department of Intensive Care Medicine, Imamura Hospital, Tosu, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
- Department of Diabetology, Shimada Hospital, Ogori, Japan
- *Correspondence: Kenji Ashida ,
| | - Ayako Nagayama
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tomoki Sako
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kouichiro Mizuochi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Masaharu Kabashima
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Satoko Yoshinobu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Shimpei Iwata
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Nao Hasuzawa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Sumika Hayashi
- Department of Diabetology, Shimada Hospital, Ogori, Japan
| | | | - Masatoshi Nomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
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Successful treatment of myxedema coma using levothyroxine and liothyronine in the setting of adrenal crisis and severe cardiogenic shock in a patient with apparent primary empty sella. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.jecr.2021.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jawed M, Osella J, Bani Hani D. A Case of Myxedema Coma Crisis Induced by Inhalation Injury. Cureus 2021; 13:e17049. [PMID: 34522527 PMCID: PMC8428158 DOI: 10.7759/cureus.17049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Myxedema coma is a life-threatening, critical condition in which many organ systems can be severely affected. It is considered the most severe presentation of hypothyroidism and should be treated immediately. Here, we discuss the case of a 58-year-old patient who presented with altered mental status, bradycardia, and hypothermia, the critical characteristics considered in this disorder after inhalation injury. In order to avoid a fatal outcome, aggressive therapy should be initiated upon presentation. This case will depict the typical presentation, the specific cause pertinent to this patient’s condition, and the management of the acute condition of myxedema coma.
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Affiliation(s)
- Muzamil Jawed
- Internal Medicine, Lincoln Medical Center, New York, USA
| | - Julieta Osella
- Internal Medicine, Lincoln Medical Center, New York, USA
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Meling Stokland AE, Dahle AL, Kloster VL, Nedrebø T, Nedrebø BG. Myxedema coma complicated by bilateral hygromas. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210067. [PMID: 34156348 PMCID: PMC8240815 DOI: 10.1530/edm-21-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 12/04/2022] Open
Abstract
SUMMARY Myxedema coma is an important differential diagnosis in critically ill patients. Early diagnosis and treatment are paramount but challenging due to a lack of diagnostic criteria. We report a case about a patient who suffered from untreated hypothyroidism for several years. Before the correct diagnosis was made, he was admitted three times due to severe constipation. Eventually, he developed myxedema coma in connection with a urinary tract infection. The course was complicated by recurrent seizures, and neuroimaging showed bilateral hygromas. Hormone replacement therapy resulted in complete recovery and regression of hygromas. To the best of our knowledge, this is the first time hygroma is reported in association with myxedema coma. LEARNING POINTS Myxedema coma is a difficult diagnosis to make due to a lack of diagnostic criteria. Cardinal features include hypothermia, bradycardia, gastrointestinal symptoms, pericardial/pleural effusions and affection of CNS. Anemia and hyponatremia are common. In case of suspected myxedema coma, neuroimaging should be a part of the evaluation in most cases. There is a possible association between longstanding/severe hypothyroidism and hygroma.
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Affiliation(s)
| | - Anne Lise Dahle
- Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway
| | | | - Torbjørn Nedrebø
- Department of Anaesthesia, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Gunnar Nedrebø
- Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Han J, Konno H, Sato T, Soloshonok VA, Izawa K. Tailor-made amino acids in the design of small-molecule blockbuster drugs. Eur J Med Chem 2021; 220:113448. [PMID: 33906050 DOI: 10.1016/j.ejmech.2021.113448] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
The role of amino acids (AAs) in modern health industry is well-appreciated. Residues of individual AAs, or their chemical modifications, such as diamines and amino alcohols, are frequently found in the structures of modern pharmaceuticals. The goal of this review article, is to emphasize that, currently, tailor-made AAs serve as key structural features in many most successful pharmaceuticals, so-called blockbuster drugs. In the present article, we profile 14 small-molecule drugs, underscoring the breadth of structural variety of AAs applications in numerous therapeutic areas. For each compound, we provide spectrum of biological activity, medicinal chemistry discovery, and synthetic approaches.
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Affiliation(s)
- Jianlin Han
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, College of Chemical Engineering, Nanjing Forestry University, Nanjing, 210037, Jiangsu, China
| | - Hiroyuki Konno
- Department of Biological Engineering, Graduate School of Science and Engineering, Yamagata University, Yonezawa, Yamagata, 992-8510, Japan
| | - Tatsunori Sato
- Hamari Chemicals Ltd., 1-19-40, Nankokita, Suminoe-ku, Osaka, 559-0034, Japan
| | - Vadim A Soloshonok
- Department of Organic Chemistry I, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel Lardizábal 3, 20018, San Sebastián, Spain; IKERBASQUE, Basque Foundation for Science, María Díaz de Haro 3, Plaza Bizkaia, 48013, Bilbao, Spain.
| | - Kunisuke Izawa
- Hamari Chemicals Ltd., 1-19-40, Nankokita, Suminoe-ku, Osaka, 559-0034, Japan.
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Bridwell RE, Willis GC, Gottlieb M, Koyfman A, Long B. Decompensated hypothyroidism: A review for the emergency clinician. Am J Emerg Med 2020; 39:207-212. [PMID: 33039222 DOI: 10.1016/j.ajem.2020.09.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Decompensated hypothyroidism, formerly known as myxedema coma, is an endocrine emergency that commonly presents with altered mental status, as well as hypothermia and depressed vital signs. The condition is often caused by an inciting event, which may lead to significant delays in the diagnosis and management of this disease. Although the incidence is low, this disease is associated with significant morbidity and mortality. Therefore, it is important for emergency clinicians to be aware of this condition. OBJECTIVE This narrative review evaluates the emergency medicine diagnosis and management of adult patients with decompensated hypothyroidism. DISCUSSION Decompensated hypothyroidism is a severe hypothyroid state associated with multiple organ failure. The diagnosis can be challenging due to similarities with more common diseases and lack of consideration of the diagnosis. Many patients may present with altered sensorium or depressed vital signs. Clinicians should obtain a thyroid stimulating hormone and free thyroxine level when considering the diagnosis. Management involves resuscitation, early steroid supplementation, thyroid hormone replacement, and treatment of the inciting event. CONCLUSIONS Decompensated hypothyroidism should be considered in the evaluation of patients with altered sensorium and depressed vital signs so as to not miss this critical diagnosis.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency, Medicine Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - George C Willis
- Department of Emergency, Medicine University of Maryland School of Medicine, 110 S. Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, United States.
| | - Michael Gottlieb
- Department of Emergency, Medicine Rush University Medical Center, Chicago, IL 60612, United States
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX, 75390, United States
| | - Brit Long
- Department of Emergency, Medicine Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
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Maldonado D, Patel U, Tarlin N. A Case of Refractory Myxedema Coma. Cureus 2020; 12:e9737. [PMID: 32944455 PMCID: PMC7489769 DOI: 10.7759/cureus.9737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We present a case of myxedema coma refractory to traditional treatments. Morbidity and mortality from myxedema coma are frequently due to a missed or delayed diagnosis. It tends to respond very well to intravenous levothyroxine replenishment as long as this treatment is initiated early. We report a case of a 71-year-old man who presented with altered mental status and severe bradycardia who was promptly diagnosed with myxedema coma on laboratory studies sent in the emergency department (thyroid-stimulating hormone 94.74, free T4 0.17, and free T3 0.69). However, while the diagnosis was recognized immediately, and he was treated aggressively with intravenous thyroxine replacement, he strangely remained refractory to treatment for a prolonged period of time. While he did respond to intravenous thyroxine initially, he dramatically decompensated each time he was transitioned to oral therapy. This case brings to question why rarely certain patients fail the transition to oral therapy, and how to treat these patients.
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Borzì AM, Biondi A, Basile F, Vacante M. Diagnosis and treatment of hypothyroidism in old people : A new old challenge. Wien Klin Wochenschr 2019; 132:161-167. [PMID: 31773270 DOI: 10.1007/s00508-019-01579-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/01/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To review the diagnosis and the treatment of both subclinical and overt hypothyroidism in old people, which could represent a challenge for the clinicians. METHODS Narrative literature review. An extensive literature search was performed using the databases of Scopus, Medline through PubMed, and Google Scholar from January 1975 to May 2019. The search terms were "hypothyroidism," "older adults," "elderly," and "myxedema." RESULTS Hypothyroidism is more common among older subjects in comparison to the younger counterparts. The hypothalamic-pituitary-thyroid axis and its hormones undergo significant changes due to the physiological aging process. For a correct diagnosis of hypothyroidism in old people clinicians must take such age-related changes into account. CONCLUSIONS The administration of replacement therapy in older adults should consider frailty, polypharmacy and a high risk to develop overtreatment symptoms. On the other hand, older patients with untreated or undertreated hypothyroidism may develop a state of myxedema coma.
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Affiliation(s)
- Antonio Maria Borzì
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia,78, 95123, Catania, Italy
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia,78, 95123, Catania, Italy
| | - Francesco Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia,78, 95123, Catania, Italy
| | - Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia,78, 95123, Catania, Italy.
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