Myxedema Coma: Cases Report and Literature Review

黏液水腫性昏迷：個案報告與文獻回顧

張洵維(Shiun-Wei Chang) ； 顏鴻章(David Hung-Tsang Yen) ； 王立敏(Lee-Min Wang) ； 林宏達(Hong-Da Lin) ； 李建賢(Chen-Hsen Lee)

《中華民國急救加護醫學會雜誌》 9卷4期 (1998/12) Pp. 156-162

https://doi.org/10.30018/JECCM.199812.0005

摘要

黏液水腫性昏迷是危及生命的內科急症之一，然而在台灣很少個案報告。我們報告兩例接受甲狀腺切除術後，長期缺乏補充甲狀腺素而導致黏液水腫性昏迷的老年個案。造成他們昏迷的誘因可能是泌尿道感染。意識改變，換氣不足，血中磷肌酸激酶，麥氨草醋酸氨基轉移酶和乳酸脫氫酶上升以及喪失心臟血管代償功能是此兩病例之共同特徵。造成病患死亡的原因可能是由於甲狀腺素補充之劑量不足（每天25μg），較晚施予氣管插管與輔助性呼吸器以及對抗生素與其他支持性療法反應不佳所造成的。相反的，存活的病患可能是由於接受高劑量之甲狀腺素補充（每天200μg），早期接受氣管插管與輔助性呼吸器，並對抗生素與支持性療法反應良好。迅速診斷，儘早給予高劑量甲狀腺素補充及呼吸道處置之積極治療對病人的存活是非常重要的。

關鍵字

急診部門 ； 黏液水腫性昏迷 ； 甲狀腺功能低下

並列摘要

Myxedema coma is a life-threatening disease rarely reported in Taiwan. We present two elderly postthyroidectomy patients with a long history of poor compliance to their thyroid hormone replacement resulting in myxedema coma, which may also be precipitated by infection such as urosepsis. Altered mental status, hypoventilation, elevation of creatine phosphokinase(CPK), aspartate aminotransferase(AST) and lactic dehydrogenase(LDH), and cardiovascular decompensation are clinical features common to both patients. The non-survivor received a lower dose of supplementary L-T4 (25μg/day), delayed airway intubation, and had a limited response to antibiotics and general supportive measures. The survivor received a high-dose of L-T4(200μg/day) and early airway intubation, and responsed positively to similar supportive treatments to the first patient. Prompt diagnosis, early aggressive treatment with high-dose L-T4 and airway management may help to improve outcome.

並列關鍵字

emergency department ； myxedema coma ； hypothyroidism