Division of Endocrinology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya 453-8511, Japan.
Endocr J. 2019 May 28;66(5):469-474. doi: 10.1507/endocrj.EJ18-0469. Epub 2019 Mar 8.
Myxedema coma is a rare endocrine emergency resulting from the decompensation of severe hypothyroidism, which is associated with a high mortality rate. It is characterized by the deterioration of mental status, hypothermia, hypotension, hyponatremia, and hypoventilation. Early disease diagnosis and advancements in intensive supportive care have reduced the mortality rate. Besides intensive supportive care, appropriate management of the underlying thyroid hormone deficiency is essential. However, as the disease is rare and unrecognized, evidence-based treatment of myxedema has not yet been established in many countries. An 84-year-old Japanese man with a history of Hashimoto's thyroiditis was referred to our hospital. On arrival, conscious disturbance, hypothermia, hypotension, and hypoventilation were observed. He had discontinued thyroid hormone replacement therapy for a year. He was diagnosed with myxedema coma. Immediately, he received intensive supportive care and a combination therapy of 200 μg levothyroxine and 50 μg liothyronine until the fifth hospital day. Subsequently, monotherapy with levothyroxine was continued at a dose of 150 μg daily. The thyroid hormone level reached the normal range a few days later, and cardiovascular disease did not develop during hospitalization. This case demonstrated the efficacy of the combination of levothyroxine and liothyronine in treating myxedema coma.
黏液性水肿昏迷是一种罕见的内分泌急症，由严重甲状腺功能减退症失代偿引起，死亡率较高。其特征为精神状态恶化、低体温、低血压、低钠血症和低通气。早期疾病诊断和强化支持性治疗的进步降低了死亡率。除了强化支持性治疗外，适当处理潜在的甲状腺激素缺乏症也很重要。然而，由于该病罕见且未被认识，许多国家尚未建立基于证据的黏液性水肿治疗方法。一名 84 岁日本男性，有桥本甲状腺炎病史，被转至我院。入院时，观察到意识障碍、低体温、低血压和低通气。他已停止甲状腺激素替代治疗一年。他被诊断为黏液性水肿昏迷。立即，他接受了强化支持性治疗和 200μg 左甲状腺素和 50μg 三碘甲状腺原氨酸联合治疗，直到入院第 5 天。随后，以 150μg 每日的剂量继续单用左甲状腺素治疗。几天后，甲状腺激素水平达到正常范围，住院期间未发生心血管疾病。该病例证明了左甲状腺素和三碘甲状腺原氨酸联合治疗黏液性水肿昏迷的疗效。
