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]
Overview
If left untreated, myxedema coma can be fatal leading to death. Common complications of myxedema coma include treatment-induced congestive heart failure in patients with coronary artery disease, increased susceptibility to infection and organic psychosis with paranoia. The mortality rate in myxedema coma is 20% to 25% despite aggressive therapy.
Natural History
If left untreated, myxedema coma is fatal. It may lead to muscle failure including heart failure, decreased respiratory drive and other features associated with hypothyroidism and complications like encephalopathy.
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.[1][2]
- 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.