Myxedema coma natural history, complications, and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Complications

Common complications of myxedema coma include:

• Treatment-induced congestive heart failure in patients with coronary artery disease
• Increased susceptibility to infection
• Organic psychosis with paranoia
• Adrenal crisis with vigorous treatment of hypothyroidism
• Hypersensitivity to opiates
• Pericardial effusion
• Cardiac tamponade

Prognosis

• The mortality rate in myxedema coma is 20% to 25% despite aggressive therapy.
• If myxedema coma is not promptly diagnosed even with immediate intervention, mortality rates are as high as 25%.
• The most common causes of death are respiratory failure, sepsis, and gastrointestinal bleeding.

Factors suggesting a poor prognosis

• • Older age
  • Persistent hypothermia
  • Bradycardia
  • Lower degree of consciousness by Glasgow Coma Scale
  • Multiorgan impairment indicated by high APACHE (Acute Physiology and Chronic Health Evaluation) II score.