Abstract

Case Report

Myxedema Coma and Acute Respiratory Failure in a Young Child: A Case Report

Rinah Elaisse R Dolores and Marion O Sanchez*

Published: 26 July, 2023 | Volume 7 - Issue 1 | Pages: 008-013

Background: Myxedema is an extreme manifestation seen in patients with untreated hypothyroidism. It is a lethal endocrine emergency, which arises when a precipitating cause overwhelms the compensatory mechanisms of the hypothyroid state.
Objectives: This case report aims to present a case of myxedema coma secondary to cretinism. It also aims to discuss how hypothyroidism leads to hypoventilation and eventually respiratory failure, as well as to discuss the epidemiology, pathophysiology, clinical manifestation, diagnosis, and management of a child with myxedema coma.
Case presentation: This is a case of a 7-year-old female, diagnosed with congenital hypothyroidism at 5 months of age, but eventually was lost to follow-up. She came back after 7 years presenting with difficulty of breathing. She was seen hypothermic, obtunded, and in severe respiratory distress. She was severely stunted and underweight with coarse facial features. Initial laboratory work-up showed elevated Thyroid Stimulating Hormone (TSH) as well as decreased tri-iodothyronine (FT3) and thyroxine (FT4). She was immediately started on levothyroxine, with noted resolution of the edema and improvement in sensorium. There was also noted improvement in the patient’s ventilation and was sent home on Continuous Positive Airway Pressure (CPAP) while asleep.
Conclusion: This case highlights the importance of having a high index of suspicion of its clinical manifestations, which could lead to earlier intervention thereby preventing further complications. A multidimensional approach is essential in managing this case, as various organ systems are involved in this condition.

Read Full Article HTML DOI: 10.29328/journal.acem.1001027 Cite this Article Read Full Article PDF

Keywords:

Myxedema coma; Cretinism; Hypoventilation; Respiratory failure

References

  1. De Sanctis V, Soliman A, Daar S, Di Maio S, Alhumaidi N, Alali M, Sabt A, Kattamis C. The Myxedema coma in children and adolescents: A rare endocrine emergency - Personal experience and review of literature. Acta Biomed. 2021 Nov 3;92(5):e2021481. doi: 10.23750/abm.v92i5.12252. PMID: 34738556; PMCID: PMC8689309.
  2. Zhu Y, Qiu W, Deng M, Zhu X. Myxedema coma: A case report of pediatric emergency care. Medicine (Baltimore). 2017 May;96(21):e6952. doi: 10.1097/MD.0000000000006952. PMID: 28538388; PMCID: PMC5457868.
  3. Thompson MD, Henry RK. Myxedema Coma Secondary to Central Hypothyroidism: A Rare but Real Cause of Altered Mental Status in Pediatrics. Horm Res Paediatr. 2017;87(5):350-353. doi: 10.1159/000449223. Epub 2016 Sep 16. PMID: 27631398.
  4. Ito H, Fukuda K, Ashida K, Nagayama A, Sako T, Mizuochi K, Kabashima M, Yoshinobu S, Iwata S, Hasuzawa N, Hayashi S, Akashi T, Nomura M. Case Report: Myxedema Coma Caused by Immunoglobulin A Vasculitis in a Patient With Severe Hypothyroidism. Front Immunol. 2022 Feb 18; 13:838739. doi: 10.3389/fimmu.2022.838739. PMID: 35251034; PMCID: PMC8895252.
  5. Behnia M, Clay AS, Farber MO. Management of myxedematous respiratory failure: review of ventilation and weaning principles. Am J Med Sci. 2000 Dec;320(6):368-73. doi: 10.1097/00000441-200012000-00003. PMID: 11149548.
  6. Fukusumi M, Iidaka T, Mouri A, Hamamoto Y, Kamimura M. Respiratory failure associated with hypoventilation in a patient with severe hypothyroidism. Respirol Case Rep. 2014 Jun;2(2):79-80. doi: 10.1002/rcr2.55. Epub 2014 Mar 13. PMID: 25473574; PMCID: PMC4184513.
  7. Divecha CA, Tullu MS, Deshmukh CT, Karande S. Myxedema Coma in a Pediatric Patient with Down Syndrome. J Pediatr Intensive Care. 2020 Mar;9(1):70-73. doi: 10.1055/s-0039-1698812. Epub 2019 Oct 24. PMID: 31984162; PMCID: PMC6978172.
  8. Vo P, Kharasch VS. Respiratory failure. Pediatr Rev. 2014 Nov;35(11):476-84; quiz 485-6. doi: 10.1542/pir.35-11-476. PMID: 25361907.
  9. Sadek SH, Khalifa WA, Azoz AM. Pulmonary consequences of hypothyroidism. Ann Thorac Med. 2017 Jul-Sep;12(3):204-208. doi: 10.4103/atm.ATM_364_16. PMID: 28808493; PMCID: PMC5541969.
  10. Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, Mukhopadhyay S, Chowdhury S. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011; 2011:493462. doi: 10.4061/2011/493462. Epub 2011 Sep 15. PMID: 21941682; PMCID: PMC3175396.
  11. Lindholm J, Laurberg P. Hypothyroidism and thyroid substitution: historical aspects. J Thyroid Res. 2011; 2011:809341. doi: 10.4061/2011/809341. Epub 2011 Jun 8. PMID: 21760981; PMCID: PMC3134382.
  12. Wall CR. Myxedema coma: diagnosis and treatment. Am Fam Physician. 2000 Dec 1;62(11):2485-90. PMID: 11130234.
  13. Safer JD. Thyroid hormone action on skin. Dermatoendocrinol. 2011 Jul;3(3):211-5. doi: 10.4161/derm.3.3.17027. Epub 2011 Jul 1. PMID: 22110782; PMCID: PMC3219173.
  14. Ross D. Myxedema coma. UpToDate. 2023. https://medilib.ir/uptodate/show/7822
  15. Root JM, Vargas M, Garibaldi LR, Saladino RA. Pediatric Patient with Altered Mental Status and Hypoxemia: Case Report. Pediatr Emerg Care. 2017 Jul;33(7):486-488. doi: 10.1097/PEC.0000000000000722. PMID: 27050737.
  16. McConahey WM. Diagnosing and treating myxedema and myxedema coma. Geriatrics. 1978 Mar;33(3):61-6. PMID: 624451.
  17. Di Mase R, Cerbone M, Improda N, Esposito A, Capalbo D, Mainolfi C, Santamaria F, Pignata C, Salerno M. Bone health in children with long-term idiopathic subclinical hypothyroidism. Ital J Pediatr. 2012 Oct 22; 38:56. doi: 10.1186/1824-7288-38-56. PMID: 23088718; PMCID: PMC3484064.
  18. Wankanit S, Mahachoklertwattana P, Anantasit N, Katanyuwong P, Poomthavorn P. Myxoedema coma in a 2-year-old girl with untreated congenital hypothyroidism: Case report and literature review. J Paediatr Child Health. 2019 Jun;55(6):707-710. doi: 10.1111/jpc.14339. Epub 2018 Dec 12. PMID: 30548708.
  19. Salisbury S. Cretinism: The past, present and future of diagnosis and cure. Paediatr Child Health. 2003 Feb;8(2):105-6. doi: 10.1093/pch/8.2.105. PMID: 20019927; PMCID: PMC2791432.

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?