Han Ko-Wen, Lin Chih-Chuan, Chen Chih-Yu, Chao Hsiao-Yun, Chien Cheng-Yu, Chen Hsien-Yi
Chang Gung University Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine Taoyuan Taiwan.
China Medical University Department of Emergency Medicine, China Medical University Hospital Taichung Taiwan.
J Acute Med. 2017 Dec 1;7(4):171-173. doi: 10.6705/j.jacme.2017.0704.006.
Hypothermic patients are rare encountered in emergency department (ED). It often represents critical condition that needs prompt management and diagnosis. Myxedema coma, which may cause severe hypothermia, is truly an endocrine emergency and needs early recognition and proper treatment. We present a case of a 47-year-old female with a history of hyperthyroidism status post thyroidectomy was brought to the ED because of progressive dyspnea associated with general weakness for one month. Hypothermia with decreased mental status and general edema were also noted. Hypothyroidism was confi rmed by laboratory examination and myxedema coma was diagnosed. The patient recovered well and there was no complication noted after intensive care with supplements of thyroxine and glucocorticoid. In conclusion, myxedema coma should be considered in decrease mental status and hypothermic patients with a history of hypothyroidism or thyroidectomy. Besides, long-standing hypothyroidism or encountering precipitating acute events, such as sepsis, cerebrovascular accident, gastrointestinal bleeding, exposure to cold, trauma or certain medications may also cause this condition. High mortality rate was reported, and the treatment should be instituted in patient with presumed myxedema coma without delay.
体温过低的患者在急诊科很少见。它通常代表需要迅速处理和诊断的危急情况。黏液性水肿昏迷可能导致严重体温过低,确实是一种内分泌急症,需要早期识别和恰当治疗。我们报告一例47岁女性患者,有甲状腺切除术后甲亢病史,因进行性呼吸困难伴全身无力1个月被送至急诊科。还发现有体温过低、精神状态减退和全身水肿。实验室检查确诊为甲状腺功能减退,并诊断为黏液性水肿昏迷。患者恢复良好,在补充甲状腺素和糖皮质激素的重症监护后未发现并发症。总之,对于精神状态减退且有甲状腺功能减退或甲状腺切除病史的体温过低患者,应考虑黏液性水肿昏迷。此外,长期甲状腺功能减退或遭遇促发急性事件,如败血症、脑血管意外、胃肠道出血、暴露于寒冷、创伤或某些药物,也可能导致这种情况。据报道死亡率很高,对于疑似黏液性水肿昏迷的患者应立即进行治疗。