Department of Internal Medicine, Reading Hospital/Tower Health, Reading, PA, USA.
Am J Case Rep. 2020 Oct 10;21:e926757. doi: 10.12659/AJCR.926757.
BACKGROUND Myxedema coma is an uncommon severe thyroid disorder that is fatal in 25-60% of cases. Although the differential diagnosis for altered mental status is extensive, including many more common causes such as infection, medication changes, electrolyte abnormalities, and exacerbation of chronic illnesses, profound hypothyroidism is an uncommon cause that can be overlooked. CASE REPORT We describe the case of a 71-year-old man on long-term amiodarone treatment for atrial fibrillation who presented with altered mental status initially ascribed to uremia, hyponatremia, and pneumonia. When his mental status did not resolve, thyroid tests showed his thyroid-stimulating hormone level was 89 μIU/mL, along with clinical criteria for myxedema coma. CONCLUSIONS We suggest that thyroid function tests should be considered in encephalopathic older adults on amiodarone.
黏液水肿性昏迷是一种罕见的严重甲状腺疾病，在 25%-60%的病例中是致命的。虽然精神状态改变的鉴别诊断范围很广，包括许多更常见的原因，如感染、药物变化、电解质异常和慢性疾病恶化，但严重的甲状腺功能减退症是一种不常见的原因，可能会被忽视。
我们描述了一例长期服用胺碘酮治疗心房颤动的 71 岁男性，他以精神状态改变为首发表现，最初归因于尿毒症、低钠血症和肺炎。当他的精神状态没有改善时，甲状腺功能检查显示他的促甲状腺激素水平为 89μIU/mL，同时伴有黏液水肿性昏迷的临床标准。
我们建议，在使用胺碘酮的脑病老年患者中，应考虑进行甲状腺功能检查。
