W Reinhardt1, K Mann. 1. Medizinische Klinik, Abteilung klinische Endokrinologie, Universitätsklinikum Essen.
Abstract
BACKGROUND: Myxedema coma is a severe life-threatening clinical state with a high mortality rate. Very often symptoms are masked because of concurrent illnesses. There are no data available about the incidence and prevalence of this disease. Therefore we conducted a survey in the Federal Republic of Germany between 1993 and 1995 by a questionnaire on the occurrence of myxedema coma. METHODS: Questionnaires were mailed to 800 departments of medicine. RESULTS: We received 168 questionnaires for further evaluation. Among those, 24 patients were classified as myxedema coma, but according to clinical data we could reclassify 12 patients as myxedema coma and 12 patients as severely hypothyroid but without coma. The mean age of the patients was 73 years. The etiology was Hashimoto's thyroiditis in 16 patients (67%), in 15 patients the thyroid disease was unknown. In 6 patients thyroid hormone therapy was withdrawn after thyroid surgery. One patient became hypothyroid after radioiodine therapy and 1 patient had secondary hypothyroidism. 19 of the 24 patients received i.v. thyroxine therapy and 11 patients received corticosteroids additionally. Six patients (25%) died. CONCLUSION: These data emphasize that myxedema coma is a rare disease (24 patients within two years in Germany) occurring especially in older patients and is associated with a high mortality rate also in non-comatose patients. In the majority of the patients myxedema coma was the first manifestation of thyroid disease.
BACKGROUND:Myxedema coma is a severe life-threatening clinical state with a high mortality rate. Very often symptoms are masked because of concurrent illnesses. There are no data available about the incidence and prevalence of this disease. Therefore we conducted a survey in the Federal Republic of Germany between 1993 and 1995 by a questionnaire on the occurrence of myxedema coma. METHODS: Questionnaires were mailed to 800 departments of medicine. RESULTS: We received 168 questionnaires for further evaluation. Among those, 24 patients were classified as myxedema coma, but according to clinical data we could reclassify 12 patients as myxedema coma and 12 patients as severely hypothyroid but without coma. The mean age of the patients was 73 years. The etiology was Hashimoto's thyroiditis in 16 patients (67%), in 15 patients the thyroid disease was unknown. In 6 patients thyroid hormone therapy was withdrawn after thyroid surgery. One patient became hypothyroid after radioiodine therapy and 1 patient had secondary hypothyroidism. 19 of the 24 patients received i.v. thyroxine therapy and 11 patients received corticosteroids additionally. Six patients (25%) died. CONCLUSION: These data emphasize that myxedema coma is a rare disease (24 patients within two years in Germany) occurring especially in older patients and is associated with a high mortality rate also in non-comatosepatients. In the majority of the patientsmyxedema coma was the first manifestation of thyroid disease.
Authors: C Cappelli; B Stanga; A Paini; E Gandossi; D Cumetti; M Castellano; M L Muiesan; E Agabiti Rosei Journal: Intern Emerg Med Date: 2007-07-18 Impact factor: 3.397