Critical Care Medicine-Endocrine Disorders>>>>>Thyroid
Question 5#

An 81-year-old female is admitted to the ICU with altered mental status. She is lethargic and does not provide a good history. On physical examination, her skin is dry and pale, and her temperature is 35°C. She is noted to have decreased deep tendon reflexes.

Which of the following clinical/physiologic derangements is most likely to be present in the patient?

A. Decreased systemic vascular resistance
B. Decreased cardiac contractility
C. Respiratory Alkalosis
D. Diarrhea
E. Hyperglycemia

Correct Answer is B


Correct Answer: B

Based on the presentation, this patient likely has severe hypothyroidism causing myxedema coma. Myxedema coma is a severe manifestation of hypothyroidism that can carry up to 50% mortality. Patients experience decreased metabolic rate and decreased oxygen consumption. Systemic vascular resistance is increased (choice A) secondary to decreased beta adrenergic activity. Myocardial depression (choice B) results in profound hypotension. Hypothermia is common, occurring in up to 88% of patients. Central respiratory depression occurs, resulting in respiratory acidosis (choice C). Decreases in gastrointestinal motility typically manifests with constipation (choice D).


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  2. Wartofsky L. Myxedema coma. J Intensive Care Med. 2007;35:687-698.
  3. Sanders V. Neurologic manifestations of myxedema coma. N Eng J Med. 1962;266:547-551.