Zhu Yueniu, Qiu Wenjuan, Deng Mengyan, Zhu Xiaodong
Pediatric Critical Care Medicine, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine Department of Pediatric Endocrinology/Genetics, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai, China.
Medicine (Baltimore). 2017 May;96(21):e6952. doi: 10.1097/MD.0000000000006952.
Myxedema coma (MC) is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental status and hypothermia. But there is no clinical guideline for such cases.
A 6-year-old Chinese girl presented with coma and hypothermia preceded by pneumonia. Her lab results were: free thyroxin (T4) 4.18 pmol/L and thyroid-stimulating hormone (TSH) > 150 μIU/mL with extremely elevated anti-thyroid peroxidase (TPO-Ab) and anti-thyroglobulin. Pneumonia, mild pleural, and pericardial effusion were seen on computed tomographic (CT) scan.
MC, autoimmune hypothyroidism, pneumonia and sepsis were diagnosed.
Gastric levothyroxine, intravenous dexamethasone and antibiotics were administered.
Her consciousness was restored and temperature returned to normal 2 days after starting levothyroxine. She was discharged two weeks later.
MC is rare but may be the initial presentation in pediatric patients with prolonged untreated hypothyroidism. Autoimmune thyroiditis could cause hypothyroidism in children. MC should be suspected in pediatric patients with altered mental status, hypothermia and cardiovascular instability. Treatment with 100 mg/m of gastric levothyroxine is an option for pediatric patients with MC.
黏液水肿性昏迷（MC）在小儿甲状腺功能减退患者中极为罕见但可致命，可导致精神状态改变和体温过低。但此类病例尚无临床指南。
一名6岁中国女孩在肺炎后出现昏迷和体温过低。她的实验室检查结果为：游离甲状腺素（T4）4.18 pmol/L，促甲状腺激素（TSH）>150 μIU/mL，抗甲状腺过氧化物酶（TPO-Ab）和抗甲状腺球蛋白极度升高。计算机断层扫描（CT）显示有肺炎、轻度胸腔和心包积液。
诊断为MC、自身免疫性甲状腺功能减退、肺炎和脓毒症。
给予胃内左甲状腺素、静脉注射地塞米松和抗生素。
开始使用左甲状腺素2天后，她的意识恢复，体温恢复正常。两周后出院。
MC罕见，但可能是长期未经治疗的小儿甲状腺功能减退患者的首发表现。自身免疫性甲状腺炎可导致儿童甲状腺功能减退。对于有精神状态改变、体温过低和心血管不稳定的小儿患者，应怀疑MC。100 mg/m的胃内左甲状腺素治疗是小儿MC患者的一种选择。
