Hypometabolic coma is an extreme form of thyroid hormone deficiency. It can be caused both by the discontinuation of the treatment of hypothyroidism and the occurrence of another serious disease along with the dysfunction of the thyroid gland. If a patient develops a hypometabolic coma, the prognosis is very poor.
Hypometabolic comacan occur as a result of untreated hypothyroidism and is an extremely dangerous condition, life-threatening. Hypothyroidism is usually associated with symptoms such as a feeling of extreme fatigue, unreasonable weight gain, and concentration disorders. Some patients - due to a significant impairment in their daily functioning - report to a doctor relatively quickly, thanks to which they receive a recommendation to supplement their missing thyroid hormones. If the thyroid dysfunction is treated, the life of the patients should not be threatened anymore, but otherwise, when hypothyroidism is not properly treated, it may lead to a thyroid crisis or a hypometabolic coma.
Hypometabolic coma: causes
Hypometabolic coma is defined as the state of extreme hypothyroidism. It can be caused by an untreated thyroid hormone deficiency, but also by overlapping hypothyroidism in some other situation. Conditions that can lead to a hypometabolic coma in a patient with hypothyroidism may include:
- severe infection (e.g. pneumonia)
- undergoing some operation
- experience significant trauma
- heart attack
- taking certain medications (e.g. beta-blockers, amiodarone or sedatives)
- worsening of heart failure
- gastrointestinal bleeding
- significant body cooling
Hypometabolic coma: symptoms
As the name of the problem itself indicates, the metabolic disorders that occur in its course lead to the fact that the patient falls into a coma. In patients with hypometabolic coma, other symptoms may also appear, such as:
- hypoxemia(reduction of oxygen in the body) with hypercapnia (increase in the concentration of carbon dioxide in the body)
- hypothermia (lowering the body temperature, which can reach as low as 24 degrees Celsius)
- drop in blood pressure
- bradycardia (slow heart rate)
- decrease in muscle tone
- weakening of tendon reflexes
- convulsions
- bradypnoe (respiratory rate reduction)
- puffiness
- hyponatraemia (decreased sodium in the blood)
Patients may also suffer from other ailments, depending on the cause of the hypometabolic coma. In laboratory tests, characteristic of hypometabolic coma are significantly reduced values of triiodothyronine (T3) and thyroxine (T4) and exceptionally elevated the level of thyroid stimulating hormone (TSH) in the blood.
Hypometabolic coma: treatment
Hypometabolic coma is a life-threatening condition, therefore it is treated in a hospital setting. Patients are administered intravenous thyroid hormone preparations, most often levothyroxine, but combinations of this hormone with triiodothyronine are also used. Important in the treatment of hypometabolic coma is also:
- correcting electrolyte disturbances (e.g. hyponatremia)
- intravenous infusion of fluids to patients
- taking care of adequate lung ventilation (usually there is a need to intubate the patient and use assisted ventilation)
- intravenous glucose administration to hypoglycemic patients
- administration of hydrocortisone (the preparation is especially used in patients admitted to the hospital in a very serious condition)
- appropriate treatment of comorbidities (especially if they most likely led to a hypometabolic coma)
Among the information on the treatment of hypometabolic coma, there were no information about the need to warm the patient. This is by no means a result of an oversight - even if the patient is severely hypothermic, the use of active heating could even harm him. The effect of heating the patient's body could lead to the expansion of his blood vessels, which could lead to shock.
Hypometabolic coma: prognosis
Due to the prognosis of those patients who develop a hypometabolic coma, hypothyroidism should not be underestimated and should always beundertake supplementation of thyroid hormone deficiencies. Hypometabolic coma is associated with a high rate of mortality - even if the condition is properly treated, death can occur in even more than one in four patients with a hypometabolic coma.
Hypothyroidism
Hypothyroidism affects about 5-7 percent of women and about 1 percent of men. The main symptoms of an underactive thyroid gland are: fatigue, dry skin, poor quality of hair and nails, and an increase in body weight. What tests should be done and how is the treatment of hypothyroidism?