MYXOEDEMA COMA

Abstract

ABSTRACT Two fatal cases of myxoedema coma are reported. Case 1 was a woman who had, 4 months previously, undergone thyroidectomy and found to have Hashimoto's goitre. Case 2 was a 81-year-old widow with no previous history of thyroid disorder. Seventy cases reported in the literature are reviewed, and the symptoms and signs, autopsy findings, and treatment of myxoedema coma are discussed on the basis of 41 definite cases. It is apparent that cold was the most important precipitating factor, since nearly all the cases occurred during the winter months. Whether infection induces coma cannot be decided with certainty. There is no evidence that myxoedema coma is caused by or complicated by an accumulation of carbon dioxide, hypoglycaemia, or hypotension. All the patients had a low serum sodium, but normal serum potassium. Autopsy was carried out on 25 patients. A remarkable number showed signs of auto-immune thyroid disorder, 5 having Hashimoto's goitre, 4 severe lymphoid infiltration in the thyroid gland, and one Riedl's goitre. Thirteen out of 17 patients who survived or improved temporarily during treatment had been given 1-triiodothyronine (TIT). Out of the 24 patients who died only 9 had received TIT. The average dose was more than twice as high in 17 patients who survived or showed temporary improvement as in 24 patients who died. Warming was tried in a number of cases, but without any convincing effect. All the patients who survived had received steroid medication, and — in addition to TIT — steroid therapy seems to be indicated in the treatment of these patients.