1/3. myxedema coma of both primary and secondary origin, with non-classic presentation and extremely elevated creatine kinase.myxedema coma is a rare, often fatal endocrine emergency that concerns elderly patients with long-standing primary hypothyroidism; myxedema coma of central origin is exceedingly rare. Here, we report a 37-year-old woman in whom classical symptoms of hypothyroidism had been absent. Six years earlier, she had severe obstetric hemorrhage and, shortly after, two subsequent episodes of pericardial effusion. On the day of admission, pericardiocentesis was performed for the third episode of pericardial effusion. Because of the subsequent grave arrhythmias and unconsciousness, she was transferred to our ICU. Prior to the endocrine consultation, a silent myocardial infarction had been suspected, based on the extremely high serum levels of creatine kinase (CK) and isoenzyme CK-MB. However, based on thyroid sonography, pituitary computed tomography, elevated titers of antithyroid antibodies and pituitary stimulation tests, the final diagnosis was myxedema coma of dual origin: an atrophic variant of Hashimoto's thyroiditis and post-necrotic pituitary atrophy (Sheehan syndrome). Substitutive therapy caused a prompt clinical amelioration and normalization of CK levels. Our patient is the first case of myxedema coma of double etiology, and illustrates how its presentation deviates markedly from the one endocrinologists and physicians at ICU are prepared to encounter. In addition, cardiac problems as those of our patient should not discourage from substitutive treatment (using L-thyroxine and the gastrointestinal route of absorption), if the age is relatively low.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
2/3. multiple sclerosis co-existent with myxedema. An autopsy case report.A 64-year-old woman developed impaired consciousness and vision, sensorimotor paresis, hypothermia, bradycardia, and edema. Symptoms fluctuated with seasonal exacerbations in winter and terminated in coma with respiratory insufficiency at age 69. High CSF protein content and low serum T4 and TSH levels were noted. Treatment with prednisolone and thyroxin considerably improved her consciousness and edema. The patient suddenly expired of pulmonary embolism. Postmortem examination revealed a marked atrophy of pituitary and thyroid glands, while multiple demyelinating plaques were disclosed in the optic tract and cervical cord. A review of the literature indicates that this is the first report of the co-existence of two such disorders.- - - - - - - - - - ranking = 2keywords = consciousness (Clic here for more details about this article) |
3/3. Drop attacks induced by hypothyroidism.Drop attacks (DA) are defined as sudden repeated falls without warning and without loss of consciousness. A variety of etiologies are known to be responsible for symptomatic DA, but the reason for idiopathic DA remains obscure. A 70-year-old woman who suffered from classic DA over a period of a year is described. The diagnostic work-up revealed severe myxedema. Treatment with eltroxin resulted in complete clinical and endocrine recovery and disappearance of DA while with discontinuation of hormone replacement therapy, DA reappeared. Thus, a direct relationship between hypothyroidism and DA can be considered.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |