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Myxedema coma is an extreme or decompensated form of hypothyroidism and while uncommon, is potentially lethal. [ 1][ 2][ 3] A person may have laboratory values identical to a "normal" hypothyroid state, but a stressful event (such as an infection, myocardial infarction, or stroke) precipitates the myxedema coma state, usually in the elderly.
The major form of thyroid hormone in the blood is thyroxine (T 4), whose half-life of around one week [4] is longer than that of T 3. [5] In humans, the ratio of T 4 to T 3 released into the blood is approximately 14:1. [6] T 4 is converted to the active T 3 (three to four times more potent than T 4) within cells by deiodinases (5′-deiodinase).
T 3 is the more metabolically active hormone produced from T 4.T 4 is deiodinated by three deiodinase enzymes to produce the more-active triiodothyronine: . Type I present in liver, kidney, thyroid, and (to a lesser extent) pituitary; it accounts for 80% of the deiodination of T 4.
The main diagnostic sign is an oral body temperature that averages well below 37.0 °C (98.6 °F). This overlaps with normal body temperature, which is usually within the range of 36.5–37.5 °C (97.7–99.5 °F). [5] [6] Wilson says that his diagnosis is confirmed if the patient responds to treatment with slow-release T3 (SR-T3).
The patient should remain in the ice bath until their body temperature falls to 102.2 degrees. Then, they can be transported to the hospital. Preparing for heat illness in a warming world
Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. [ 3] Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. [ 3] Some, however, use the terms interchangeably. [ 5]
The hypothalamic–pituitary–thyroid axis ( HPT axis for short, a.k.a. thyroid homeostasis or thyrotropic feedback control) is part of the neuroendocrine system responsible for the regulation of metabolism and also responds to stress. As its name suggests, it depends upon the hypothalamus, the pituitary gland, and the thyroid gland .
Thyroid storm is characterized by an acute onset of symptoms of hyperthyroidism ( fast heart rate, restlessness, agitation) accompanied by other features such as fever (temperatures often above 40 °C/104 °F), hypertension, mental status changes, diarrhea, and vomiting. [ 11]