On these “Gold Standard Internal Medicine Facts” pages you will find Free:
- USMLE Audio Review files from our “Gold Standard USMLE Reviews”
- Transcriptions of those files
- And videos (as they become available)
The idea is that you can review for the USMLE online by:
- Listening to the Audio
- Following along with the transcription
- Or by watching the video (if available)
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Let’s start our USMLE Review with Hypothyroidism and Hyperthyroidism from the Gold Standard USMLE Foundations of Medicine Audio Review program.
Play USMLE Audio MP3 10 11 Myxedema Coma Below
Begin 10 11 Myxedema Coma Transcription
Next we’ll look at a serious complication that can occur with adult hypothyroidism. This condition is basically the end-stage of unchecked hypothyroidism. It’s characterized by hypoglycemia, hyponatremia, hypothermia, hypoventilation, progressive weakness, stupor, shock, and death.
What is this condition?
- Myxedema Coma.
Student doctor please pause the tape and repeat a list of symptoms of myxedema coma beginning with four conditions starting in hypo. Myxedema coma is the end-stage of unchecked hypothyroidism.
- Symptoms include hypoglycemia, hyponatremia, hypothermia, hypoventilation, progressive weakness, stupor, shock, and death.
While still a relatively rare development at this time, why may myxedema coma become more common in the future, it has to do with radioiodine? Go ahead and pause the tape. Increasing use of radioiodine therapy for Graves’ disease will result in more cases of permanent hypothyroidism with more incidences of myxedema coma.
Why does myxedema coma carry an extremely high mortality rate among the patient population it usually infects?
- Myxedema coma occurs most frequently in older patients with underlying pulmonary and vascular disease so mortality is high.
Let’s talk a little about the presentation of the typical hypothyroid patient with progressing myxedema coma.
What are three previous factors to inquire after in the history of the patient or family member if the patient is already comatose?
- Ask if the patient recalls any previous thyroid disease or thyroidectomy or radioiodine therapy.
What is a likely progression in the medical history of the myxedema patient? Please pause the tape.
- There is typically a gradual onset of lethargy progressing to stupor or coma. Examination of the myxedema coma patient reveals bradycardia and marked hypothermia, with body temperatures as low as seventy-five degrees Fahrenheit. Please pause the tape again and describe the typical appearance of the myxedema coma patient. Start with whether men or women are more commonly afflicted. The myxedema coma patient more often than not is an elderly woman, obese, with yellowish skin, large tongue, hoarse voice, puffy eyes, thin hair, ileus, and slow reflexes. Other kinds of illnesses associated with hypothyroidism may also be present. We’ll name four.
First, clotting of blood in a brain vessel?
- Cerebral thrombosis.
Second, which GI complication?
- GI bleeding.
Third, sudden insufficiency of arterial or venous blood supply to an area of the heart muscle?
- Myocardial infarction.
And fourth, inflammation of the lung parenchyma?
Student doctor please pause the tape and summarize for myxedema coma in the following areas: frequency of incidence now and in the future, mortality rate, history, examination, and typical patient profile.
- Cases of myxedema coma, the rare at present, will likely increase in the future with use of radioiodine treatment for Graves’ disease and its resultant permanent hypothyroidism. The mortality rate with myxedema coma is extremely high since it occurs mostly in elderly patients with pre-existing pulmonary and vascular disease. History looks specifically for previous thyroid disease or thyroidectomy and radioiodine therapy. Medical history is a gradual onset of lethargy progressing to stupor or coma. Examination reveals bradycardia and hypothermia as low as seventy-five degrees Fahrenheit. The myxedema coma patient is typically an obese, elderly female with yellowish skin, large tongue, hoarse voice, puffy eyes, thin hair, ileus, and slow reflexes.
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