April 14, 2014 Outcome table: 40-year-old woman with suspected myxedematous comaEtiology/risk factors Structural/physiological alterations Clinical manifestations/complicationsEtiology: • Severe hypothyroidism with low T3 hormone levels and T4Types:• Primary: alteration of the thyroid gland (No TH)o Can be autoimmunity (Hashimoto's thyroiditis), surgical intervention (thyroidectomy), iatrogenic (ablation of radioactive iodine), congenital. The most common • Secondary: alteration of the pituitary gland (no TSH) • Tertiary: alteration of the hypothalamus (no TRH) • Subclinical: no manifestation Risk factors: • People with a history of chronic hypothyroidism • Iodeo deficiency Iodine component in the creation of thyroid hormoneso Uncommon in the United States due to fortified foods, but common worldwide• Drugs: propylthiouracel, methimazole, anesthesia, barbituates, beta blockers, diuretics, lithium, narcotics, phenothiazines, phenytoin (modifies the binding of T4 to TBG), rifampin, tranquilizers• Womenso 10 times more common in womeno Women are more likely to develop autoimmune diseaseso Patient is at higher risk• 65 years and oldero Manifest HPO: 1 .7%o Subclinical HPO: 13.7%o Patient is at lower risk because <65 years old• Postpartum: 6 to 8.8%• Winter months/ Coldo 90% occur during winter months• Infection• Type 1 diabeteso 5-8% risko 25% postpartum • Pulmonary hypertension (> 25 mmHg)o 23 to 49%• Down syndrome:o 10 to 40%: naturally high level of anti-peroxidase antibodies thyroid• Turner syndrome: o 36%: naturally elevated levels of anti-thyroid peroxidase antibodies• First-degree relatives with autoimmune hyperactivity/hypothyroid disorderPrevalence:• 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). Myxedema 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). Myxedema Coma: a new look at an old crisis. Journal of Thyroid Research, 1-7. Mistovich, J., Krost, W., & Limmer, D. (2007). Beyond the essential: 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.