Rajendran Arjun, Bhavani Nisha, Nair Vasantha, Pavithran Praveen V, Menon V Usha, Kumar Harish
Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Cochin, India.
Eur Thyroid J. 2021 Mar;10(1):52-58. doi: 10.1159/000507855. Epub 2020 Jun 11.
Myxedema coma is an endocrine emergency with a very high mortality rate. As per the American Thyroid Association, initial thyroid hormone replacement for myxedema coma should be intravenous levothyroxine (LT4). However, in India, the availability of intravenous LT4 is limited. Often, crushed LT4 tablets are given through the enteral route when parenteral therapy is unavailable. No data or protocol is available for the administration of oral LT4 in myxedema coma. The aim of this study was to assess the effectiveness of oral LT4 in patients diagnosed with myxedema coma and to formulate a protocol for oral LT4 that can be used to guide the treatment of patients when intravenous LT4 is unavailable.
This retrospective observational study included patients diagnosed with myxedema coma between January 2010 and December 2019. The diagnosis of myxedema coma was based on the diagnostic scoring system for myxedema coma proposed by Popoveniuc et al. [Endocr Pract. 2014 Aug;20(8):808-17]. Dosing of oral LT4 was decided as per our institutional protocol.
Fourteen patients (11 males and 3 females) with a median age of 67.5 years (range 11-82) with myxedema coma were included. All patients had central nervous system manifestations, and sepsis was the most common precipitating factor. The median myxedema score was 72.5 (normal ≤25), and the median length of hospital stay was 12 days (range 3-18). The oral LT4 regimen consisted of a loading dose of 300-500 μg, followed by taper over the next 3-5 days. With this regimen, 13 patients survived, and only 1 patient died.
Oral LT4 is an effective treatment option for myxedema coma when intravenous LT4 is unavailable.
黏液性水肿昏迷是一种内分泌急症，死亡率极高。根据美国甲状腺协会的建议，黏液性水肿昏迷的初始甲状腺激素替代治疗应采用静脉注射左甲状腺素（LT4）。然而，在印度，静脉注射LT4的供应有限。当无法进行肠外治疗时，通常会通过肠内途径给予碾碎的LT4片剂。目前尚无关于黏液性水肿昏迷患者口服LT4给药的数据或方案。本研究的目的是评估口服LT4对诊断为黏液性水肿昏迷患者的有效性，并制定口服LT4的方案，以便在无法获得静脉注射LT4时用于指导患者的治疗。
这项回顾性观察性研究纳入了2010年1月至2019年12月期间诊断为黏液性水肿昏迷的患者。黏液性水肿昏迷的诊断基于Popoveniuc等人提出的黏液性水肿昏迷诊断评分系统[《内分泌实践》。2014年8月；20(8):808 - 17]。口服LT4的剂量根据我们机构的方案确定。
纳入了14例黏液性水肿昏迷患者（11例男性和3例女性），中位年龄为67.5岁（范围11 - 82岁）。所有患者均有中枢神经系统表现，脓毒症是最常见的诱发因素。黏液性水肿评分中位数为72.5（正常≤25），住院时间中位数为12天（范围3 - 18天）。口服LT4方案包括300 - 500μg的负荷剂量，随后在接下来的3 - 5天逐渐减量。采用该方案，13例患者存活，仅1例患者死亡。
当无法获得静脉注射LT4时，口服LT4是黏液性水肿昏迷的一种有效治疗选择。
