14 April 2014Path diagram: 40-year-old woman with suspected myxedematous comaEtiology/risk factors Structural/physiological alterationsClinical manifestations/complicationsEtiology:• Severe hypothyroidism with low levels of T3 and T4 hormonesTypes:• Primary : thyroid gland impairment (n TH)o May be autoimmunity (Hashimoto's thyroiditis), surgery (thyroidectomy), iatrogenic (radioactive iodine ablation), congenital More common• Secondary: pituitary gland impairment (no TSH)• Tertiary: hypothalamic impairment (without TRH) • Subclinical: No manifestations Risk factors: • People with history of chronic hypothyroidism • Iodine deficiency iodine component in the creation of thyroid hormone Uncommon in the United States due to fortified foods but common in worldwide • Drugs: propylthiouracel, methimazole, anaesthetics, barbituates, beta blockers, diuretics, lithium, narcotics, phenothiazines, phenytoin (alters the binding of T4 to TBG), rifampin, tranquilizers • In women, therefore 10 times more common in womeno Women are more likely to develop autoimmune diseases The patient is at higher risk• 65 years and oldero Obvious HPO: 1.7%o Subclinical HPO: 13.7%o The patient is at lower risk because <65 years• Postpartum: 6 – 8.8%• Winter months/colds 90% occur in the winter months• Infection• Type 1 diabetes risk 5-8%o 25% postpartum• Pulmonary hypertension (>25 mmHg)o 23 – 49%• Down:o 10-40%: natural high level of anti-thyroid peroxidase antibodies • Turner syndrome:o 36%: high natural anti-thyroid peroxidase antibodies • First degree relatives with autoimmune hyper/hypothyroid disorder Prevalence: • United States: 0.3% • Whites: 5.1% • Hispanics: 4.1% • Blacks: 1.7 %Incidence...... middle of paper ......rd. 23 (18) 48-56.Gupta, K. (2013). Myxedematous coma: a sleeping giant in clinical practice. American Journal Of Medicine, 126(12), e3-4.doi:10.1016/j.amjmed.2013.07.037Hypothyroidism. Clinical key. Retrieved from https://www.clinicalkey.com/topics/endocrinology/hypothyroidism.html#806Kostoglou-Athanassiou I, Ntalles K (2010). Hypothyroidism: new aspects of an old disease. PMC, 14, 82-7.Matthew V., Misgar R., Ghosh S., Mukhopadhyay P., Roychowdhury P., Pandit L.,… Chowdhury S (2011). Coma Myxedema: a new look at an old crisis. Journal of Thyroid Research, 1-7.Mistovich, J., Krost, W., & Limmer, D. (2007). Beyond the basics: endocrine emergencies. Part 2: Hypothyroidism and myxedema coma.EMS Magazine, 36(11), 66-9.Porth, C. (2005). Pathophysiology: Concepts of Altered Health States (8th ed.). Philadelphia: Lippincott Williams & Wilkins.