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Case Report A Case of Myxedema Coma with Severe Hypoventilation.
Jin Young Shim, Seung Won Lee, Hyun Woo Lee, Joon Hyuck Choi, Young Jun Song, Hyoung Suk Lee, Yoon Sok Chung, Kwan Woo Lee
Endocrinology and Metabolism 2004;19(2):203-208

Published online: April 1, 2004
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Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.

A myxedema coma, representing the extreme feature of hypothyroidism is rare. Despite early vigorous treatment, a myxedema coma is associated with a mortality rate as high as 60%. Herein, a case of a myxedema coma, with severe hypoventilation, is described. When the patient arrived at the emergency room, she complained of dyspnea and general weakness, and was of a drowsy mental status. 7 days after admission, she was more confused and disoriented, and respiratory insufficiency had developed. Although levothyroxine was continued and her respiration improved, she still had a confused mentality and seizure developed. Despite medication her consciousness did not improve, so was discharged in despair by her family members. The respiratory abnormality with a myxedema coma is a depressed ventilatory response to hypercapnea, resulting in a decrease in alveolar ventilation, with progressive CO2 retention. An upper airway obstruction, especially during sleep, and neuromuscular dysfunction in breathing may be shown in hypothyroidism. Therefore, a myxedema coma, accompanied by severe hypoventilation, should be intensively treated with thyroid hormone replacement therapy and mechanical ventilatory support

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