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Myxedema Coma vs severe hypothyroidism
First #Medtwitter #Tweetorial #ICUconsult
Do I have the correct diagnosis ?
Why steroids ? Why cortisol ?
Do I wake up endo at 3AM ? #endotwitter
Looking for answers ?
A thread
#Medthread #MedStudentTwitter #pccm
First #Medtwitter #Tweetorial #ICUconsult
Do I have the correct diagnosis ?
Why steroids ? Why cortisol ?
Do I wake up endo at 3AM ? #endotwitter
Looking for answers ?
A thread
#Medthread #MedStudentTwitter #pccm
Myxedema coma is a medical emergency. Period.
Act fast, efficiently and start treatment if your pretest probability is very high. No TSH ? No prob.
We don't wait for a CTA in a patient with massive PE and don't wait for an arterial duplex in acute limb ischemia right? same here
Act fast, efficiently and start treatment if your pretest probability is very high. No TSH ? No prob.
We don't wait for a CTA in a patient with massive PE and don't wait for an arterial duplex in acute limb ischemia right? same here
Ok How do I know/suspect myxedema ?
1. #History (if severe pt may be obtunded, ask family!)
2. #physical #exam (thyroid scars, delayed reflexes, macroglossia, slow mentation, bradycardia, hypothermia, low BP, myxedema in extremities....)
when in doubt @uptodate
1. #History (if severe pt may be obtunded, ask family!)
2. #physical #exam (thyroid scars, delayed reflexes, macroglossia, slow mentation, bradycardia, hypothermia, low BP, myxedema in extremities....)
when in doubt @uptodate
Before we go into diagnosis 2 things to ask/workup - Just like in #DKA always question #WHY the patient went into myxedema crisis ? #WHAT tipped them into it ?
Great table courtesy @LITFLblog
https://litfl.com/wp-content/uploads/2019/02/myxoedema-coma-features-diagn1.pdf
Great table courtesy @LITFLblog
https://litfl.com/wp-content/uploads/2019/02/myxoedema-coma-features-diagn1.pdf
Looking for a scoring system to help diagnose myxedema? well we have one, limited utility but personally like it in cases where i'm borderline about the diagnosis #endotwitter #Endocrinology @SudiSarkar
@NadiaJamilMD
https://journals.aace.com/doi/abs/10.4158/EP13460.OR
@NadiaJamilMD
https://journals.aace.com/doi/abs/10.4158/EP13460.OR
What now ? Labs ! TSH T4 Cortisol BEFORE you start treatment. confirm prim/sec hypothyroidism + r/o adrenal insufficiency (2/2 associated hypopituitarism, blunted ACTH stress response due to disease)
no steroids = possible adrenal crisis
better to always be safe than sorry
no steroids = possible adrenal crisis
better to always be safe than sorry
steroids +thyroxine looked/found potential triggers, 
Add T3? Rationale 1. faster action 2. more active 3. hypothesized that conversion from T4 to T3 is impaired in critical illness.
No general consensus - use what you have
And yes ok you can call endo now
Hope this was useful.
Would love to hear any feedback
@msiuba @AvrahamCooperMD @MSharifpourMD @emily_fri @MegriMohammed @EmmGeezee @laxswamy @MDNidhi @MedTweetorials @sargsyanz @tony_breu @WesElyMD @abbyWUim @MDaware @SkylerLentz @nickmmark @TheRealDoctorT @jmugele @PulmCrit
Would love to hear any feedback
@msiuba @AvrahamCooperMD @MSharifpourMD @emily_fri @MegriMohammed @EmmGeezee @laxswamy @MDNidhi @MedTweetorials @sargsyanz @tony_breu @WesElyMD @abbyWUim @MDaware @SkylerLentz @nickmmark @TheRealDoctorT @jmugele @PulmCrit
Paging @medpedshosp @gradydoctor @thecurbsiders @ShreyaTrivediMD @DoctorVig @DocWithBowtie
may I pls have some hospitalist feedback ? Have you guys seen myxedema on the floor and managed without ICU level of care?
may I pls have some hospitalist feedback ? Have you guys seen myxedema on the floor and managed without ICU level of care?
