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Amiodarone induced myxedema coma hypothyroidism: Amiodarone-Induced Myxedema Coma

Of note, thyroid function tests 2 years prior were normal. Arch Intern Med.

Ethan Walker
Tuesday, February 21, 2017
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  • The isoproterenol improved both his heart rate and blood pressure, and the transcutaneous pacer was turned off. Open in a separate window.

  • Given the nature of these symptoms, it is important to be vigilant in considering myxedema coma in the differential diagnosis to prompt appropriate treatment.

  • She had been staying at the nursing home for the last 2 months as part of rehabilitation after she had fallen and sustained fractures of her ribs and compression fractures of thoracic vertebrae.

  • It occurs most frequently in older adults, defined as above the sixth decade of life [ 1 ].

  • If the patient has hypopituitarism, the level of TSH is not increased.

Publication types

Tsitouras PD. His amiodarrone caught him before he fell so he did not sustain a head injury. Thyroxine therapy in patients with severe nonthyroidal illnesses and low serum thyroxine concentration. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Hypothyroidism is diagnosed with high serum TSH and low free T4 levels.

Serum thyroid-stimulating hormone TSH was noted to be On exam, her skin was dry and cold. Myxedema amiodsrone is an extreme complication of hypothyroidism in which patients exhibit multiple organ abnormalities and progressive mental deterioration. Hence, glucocorticoid supplementation with hydrocortisone at a dose of 50— mg intravenously every 6—8 h is given for the first 7—10 days, after which it can be tapered and the further dose determined by the clinical response. The earliest reported cases of amiodarone-associated myxedema were by Guinet, who reported two cases in and [ 12 ].

A mg tablet contains about Predisposing factors myxedemma female sex, history of hypothyroidism, recent surgery, infection, trauma, hypothermia, and certain medications that affect thyroid function, as was the case in our patient. Even with previously normal thyroid function, amiodarone-induced myxedema coma should still be considered. The clinical presentation can be non-specific; however, symptoms may include lethargy, hypothermia, psychosis, altered mental status, periorbital swelling, lid ptosis, macroglossia, bradycardia, decreased cardiac output, pericardial effusion, prolonged QTc, hypoventilation, hypercapnia, and respiratory failure, many of which are compounded into the myxedema coma score used in diagnosis [ 89 ]. At that point, nearly 48 h after admission, thyroid function levels were assessed. Thyroid function should also be considered even in previously undiagnosed hypothyroidism.

Dialysis was recommended for his acute kidney injury. Arch Med Sci. Twelve hours after the initiation of therapy, FT4 was 0. A year-old man was found to have bradycardia, hypothermia and respiratory failure 3 weeks after initiation of amiodarone therapy for atrial fibrillation.

Introduction

The patient had experienced a syncopal episode in the parking lot of a restaurant after having dinner. Treatment of myxoedema coma—factors associated with fatal outcome. Treatment with thyroid hormone replacement and stress-dose steroids should be initiated without delay while laboratory tests are pending.

  • We present a case of myxedema coma in the setting of chronic amiodarone intake. Hypothermia: an easy-to-miss, dangerous disorder in winter weather.

  • Minerva Endocrinol.

  • Some authorities advocate empiric therapy with broad-spectrum intravenous antibiotics.

  • Amiodarone inhibits A the peripheral conversion of T4 to T3 by inhibiting the enzyme 5'-deiodinase that converts T4 to T3 both within peripheral tissues and within the pituitary gland, B the entry of T4 into the peripheral tissues, and C the effect of T3 on thyroid-responsive tissues.

  • The earliest reported cases of amiodarone-associated myxedema were by Guinet, who reported two cases in and [ 12 ]. Compr Ther.

  • Abstract Amiodarone is a potent new antiarrhythmic drug that has multiple effects on thyroid function, including inhibition of extrathyroidal triiodothyronine production and rarely, iodine-induced hypothyroidism.

Conclusions: We suggest that thyroid function tests should be considered in encephalopathic older adults on amiodarone. In addition coma hypothyroidism physiologic changes, older adults are generally on numerous medications and have more chronic diseases, which increases the risk for secondary hypothyroidism [ 5 ]. We suggest that thyroid function tests should be considered in encephalopathic older adults on amiodarone. The initial exam showed a confused and forgetful patient who was alert and oriented to person and place only, which was a change from baseline per family over the last 2 months. Am J Med Sci. He was transferred to the Intensive Care Unit and intubated as he was unable to protect his own airway.

ALSO READ: Hypothyroidism Hair Loss Permanent Treatment

National Center for Biotechnology InformationU. A chest X-ray showed cardiomegaly, pulmonary vascular congestion, and new, small bilateral pleural effusions. At that point, nearly 48 h after admission, thyroid function levels were assessed. The clinical presentation can be non-specific; however, symptoms may include lethargy, hypothermia, psychosis, altered mental status, periorbital swelling, lid ptosis, macroglossia, bradycardia, decreased cardiac output, pericardial effusion, prolonged QTc, hypoventilation, hypercapnia, and respiratory failure, many of which are compounded into the myxedema coma score used in diagnosis [ 89 ]. Amiodarone is a potent new antiarrhythmic drug that has multiple effects on thyroid function, including inhibition of extrathyroidal triiodothyronine production and rarely, iodine-induced hypothyroidism.

Myxedema coma in the elderly. The molecular impact of iodine on the thyroid is well established. Thyroid diseases in elderly. Extreme longevity is associated with increased serum thyrotropin. The molecular chemistry of this medication includes an iodinated benzofuran derivative comprised of 2 iodine atoms.

Background

Myxedema coma induced by short-term amiodarone therapy. It occurs most frequently in older adults, defined as above the sixth decade of life [ 1 ]. Abstract A year-old man was found to have bradycardia, hypothermia and respiratory failure 3 weeks after initiation of amiodarone therapy for atrial fibrillation. Although the differential diagnosis for altered mental status is extensive, including many more common causes such as infection, medication changes, electrolyte abnormalities, and exacerbation of chronic illnesses, profound hypothyroidism is an uncommon cause that can be overlooked.

  • These movements began about 2 months previously, involved all four extremities and had worsened in the last 5 days. Arq Bras Endocrinol Metabol.

  • Antithyroid peroxidase was negative. Try out PMC Labs and tell us what you think.

  • It is characterized by severe hypothyroidism resulting in altered mental status, bradycardia, and hypothermia.

  • Amiodarone use may result in both hypothyroidism and hyperthyroidism.

  • Gov't, P.

Case Report: We describe the case of a year-old man on long-term amiodarone treatment for atrial fibrillation who presented with altered mental status initially ascribed to uremia, hyponatremia, and pneumonia. The patient also had multifocal pneumonia, which can commonly cause acute confusion in older adults. Olsen CG. In review of this case, there were many reasons why the diagnosis of myxedema coma may have been initially missed. Conclusions: We suggest that thyroid function tests should be considered in encephalopathic older adults on amiodarone.

Gov't, P. Even with previously normal thyroid function, amiodarone-induced myxedema coma should still be considered. Support Center Support Center. We suggest that thyroid function tests should be considered in encephalopathic older adults on amiodarone. The thyroid arm of the Framingham study showed that 5.

The molecular chemistry of this medication includes an iodinated benzofuran derivative comprised of 2 iodine atoms. This response to thyroxine suggests that thyroxine itself may have biologic activity and participate directly in regulation of thyrotropin secretion. Myxedema coma is the most severe sequela of hypothyroidism.

Sign In or Create an Account. Abdominal distension. It is also known to further benefit patients suffering from left ventricular systolic dysfunction due to its minimal negative inotropic action [ 1 ]. Most authorities therefore recommend use of T 4 alone. A report from Spain presents a global incidence rate ofper year, also commonly found in women and elderly [ 14 - 15 ].

  • Physicians should include hypothyroidism in the differential diagnosis of every patient with hyponatremia. An adrenocorticotropic hormone stimulation test can be administered if clinically warranted.

  • This response to thyroxine suggests that thyroxine itself may have biologic activity and participate directly in regulation of thyrotropin secretion.

  • To note, he had altered mental status prior to arrival and was unresponsive upon arrival. Serum thyroid-stimulating hormone TSH was noted to be

  • However, myxedema from amiodarone therapy is quite rare.

  • Thyroid diseases in elderly.

  • Oxford University Press is a department of the University of Oxford. New issue alert.

Open in a separate window. Advance article alerts. Because of the possibility of secondary hypothyroidism and associated hypopituitarism, hydrocortisone should be administered until adrenal insufficiency has been ruled out. Close mobile search navigation Article Navigation. She remained in sinus rhythm during her entire hospital stay. Factors associated with mortality of myxedema coma: report of eight cases and literature survey.

Antithyroid peroxidase was negative. References: 1. Arch Med Sci. This case ihduced the most thoroughly investigated case of amiodarone-induced myxoedema coma with a history significant for subclinical thyroid disease. Olsen CG. Although the differential diagnosis for altered mental status is extensive, including many more common causes such as infection, medication changes, electrolyte abnormalities, and exacerbation of chronic illnesses, profound hypothyroidism is an uncommon cause that can be overlooked. Corresponding Author: Emily Zagorski, e-mail: gro.

Historical Features

Indued the differential diagnosis for altered mental status is extensive, including many more common causes such as infection, medication changes, electrolyte abnormalities, and exacerbation of chronic illnesses, profound hypothyroidism is an uncommon cause that can be overlooked. Corresponding Author: Emily Zagorski, e-mail: gro. Twelve hours after the initiation of therapy, FT4 was 0. A mg tablet contains about

He received intravenous fluids, vasopressor therapy myxedema coma hypothyroidism stress dose steroids; he was intubated and admitted to the intensive care unit. The patient hypothyroirism had no documented previous thyroid disorder. He was transferred to the Intensive Care Unit and intubated as he was unable to protect his own airway. In review of this case, there were many reasons why the diagnosis of myxedema coma may have been initially missed. Author information Article notes Copyright and License information Disclaimer. This case represents the most thoroughly investigated case of amiodarone-induced myxoedema coma with a history significant for subclinical thyroid disease.

Myxedema coma: Pathophysiology, therapy, and factors affecting prognosis. Nonpitting edema of the lower extremities amiodarone induced myxedema coma hypothyroidism sometimes present. Amiodarone inhibits A the peripheral conversion of T4 to T3 by inhibiting the enzyme amiodaroone that converts T4 to T3 both within peripheral tissues and within the pituitary gland, B the entry of T4 into the peripheral tissues, and C the effect of T3 on thyroid-responsive tissues. Arch Med Sci. Patients with hypothyroidism may exhibit a number of physiologic alterations to compensate for the lack of thyroid hormone. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Myxesema was alert and oriented to time, place and person and verbalizing normally. It's all in the face: amiodarone-induced myxedema font weight css w3c tutorial skin pigmentation. J Endocrinol Invest. Conversely, physicians should be alert to the possibility of myocardial infarction as a triggering event for myxedema coma. This case suggests the importance of thyroid panels in the management of patients who are using amiodarone long-term. To note, he had altered mental status prior to arrival and was unresponsive upon arrival. Elevated diastolic blood pressure—early.

Amiodarone is a potent new antiarrhythmic drug that has multiple effects on thyroid function, including inhibition of extrathyroidal triiodothyronine production and rarely, iodine-induced hypothyroidism. The only two cases of amiodarone-induced myxoedema coma in the literature report patient death despite supportive therapy and thyroid hormone replacement. Thyroid diseases in elderly. The 24 hour excretion of iodine was mcg mcg.

The aging thyroid: thyroid deficiency in the Framingham Study. Excess iodine also inhibits the entry of Hypothyroidism to the peripheral tissue. A mg tablet contains about Given the nature of these symptoms, it is important to be vigilant in considering myxedema coma in the differential diagnosis to prompt appropriate treatment. Abstract Amiodarone is a potent new antiarrhythmic drug that has multiple effects on thyroid function, including inhibition of extrathyroidal triiodothyronine production and rarely, iodine-induced hypothyroidism.

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Acute uremia causing mental status changes in the setting of stage 5 chronic kidney disease amiodarone induced myxedema coma hypothyroidism addressed early with hemo-dialysis through a temporary dialysis catheter. Gov't, P. The molecular impact of iodine on the thyroid is well established. The initial exam showed a confused and forgetful patient who was alert and oriented to person and place only, which was a change from baseline per family over the last 2 months. At that point, nearly 48 h after admission, thyroid function levels were assessed. Antithyroid peroxidase was negative. Twelve hours after the initiation of therapy, FT4 was 0.

  • Of further clinical importance, the administration of isoproterenol significantly improved a hemodynamically unstable patient suffering from hypothyroidism. Amiodarone-induced thyrotoxicosis has been suggested to cause de novo cases of hypothyroidism in which many undiagnosed cases lead to myxedema coma MC.

  • These mechanisms can lead to increased serum T4 and decreased serum T3 concentrations in euthyroid patients on long-term amiodarone therapy [ 13 ].

  • Abstract Introduction Amiodarone is widely used as a rhythm-conversion agent in atrial fibrillation.

  • Endocr J.

  • Hypothyroidism has been reported to develop up to 39 months after initiation of amiodarone.

Mental status returned to alert and oriented times 3 within 1 week after treatment initiation. Discussion It can be quite difficult to decipher the exact etiology of altered mental status in an older adult with multiple comorbidities. The aging process plays a significant role in fluctuating levels of thyroid hormones, including thyroid-stimulating hormone TSHtriiodothyronine T3and thyroxine T4 [ 2 ]. Successful treatment of myxedema coma with a combination of levothyroxine and liothyronine.

Although it is important to hyothyroidism common causes of confusion, including infection, exacerbation of chronic illness, and electrolyte abnormalities, it is also important to note that multiple conditions can coexist. The only two cases of amiodarone-induced myxoedema coma in the literature report patient death despite supportive therapy and thyroid hormone replacement. He received intravenous fluids, vasopressor therapy and stress dose steroids; he was intubated and admitted to the intensive care unit. An electrocardiogram showed a prolonged QTc of ms. Substances Anti-Arrhythmia Agents Amiodarone. A mg tablet contains about Support Center Support Center.

A — Comparison of chest X-rays at presentation with pre-treatment and last known normal chest X ray. Try out PMC Labs and tell us what you think. Effects of amiodarone on thyroid function.

Abstract Amiodarone is a potent new amiodarone induced myxedema coma hypothyroidism drug that has multiple effects on thyroid function, including inhibition of extrathyroidal triiodothyronine production ckma rarely, iodine-induced hypothyroidism. Amiodarone-induced myxedema coma: Reports and literature review. Myxedema coma is the most severe sequela of hypothyroidism. In this particular case, we believe that long-term use of amiodarone induced his thyroid dysfunction in the setting of acute infection, uremia, and hyponatremia.

Parenteral and oral thyroxine therapy promptly reduced serum thyroid-stimulating hormone concentrations without increasing the patient's very low serum triiodothyronine concentration. This case represents the most thoroughly investigated case of amiodarone-induced myxoedema coma with a history significant for subclinical thyroid disease. Amiodarone is known to cause both hyperthyroidism and hypothyroidism. The molecular impact of iodine on the thyroid is well established. The patient concurrently had more common causes of acute encephalopathy, including uremia due to his poor baseline kidney function, infectious pneumonia, and hyponatremia.

References

This report describes a man with recurrent ventricular tachycardia in whom hypothyroidism developed during amiodarone therapy and who died of probable myxedema coma. Here, we present a case of amiodarone-associated myxedema coma in an older adult with multiple chronic conditions and previously normal thyroid hormone levels. Substances Anti-Arrhythmia Agents Amiodarone.

Presentation of myxedema coma to the Emergency Department following recent initiation of amiodarone. Support Center Support Center. Am J Med Sci. Author information Article notes Copyright and License information Disclaimer.

Abstract Amiodarone is a class III amiodarone induced myxedema coma hypothyroidism drug often used to treat supraventricular and ventricular arrhythmias with high efficacy. Am Heart J. Compr Ther. Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. Most authorities recommend treatment with intravenous levothyroxine T 4 as opposed to intravenous liothyronine T 3. When there is a high index of suspicion, serum TSH, free T4, and cortisol should be obtained.

Epidemiology

Amiodarone-induced myxedema coma. Haemodynamic improvement, along with complete recovery of mental status, occurred after 48 h. Amiodarone-induced myxedema coma is a rare condition that has previously been reported in the literature less than 20 times since [ 9 — 11 ].

J Endocrinol. Please review our privacy policy. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. Patient had no previous history of thyroid surgery or radioiodine therapy. Saint Joseph Hospital.

Thyroid diseases in elderly. Arch Intern Med. Abstract Amiodarone is a potent new antiarrhythmic drug that has multiple effects on thyroid function, including inhibition of extrathyroidal triiodothyronine production and rarely, iodine-induced hypothyroidism. Substances Anti-Arrhythmia Agents Amiodarone. At that point, nearly 48 h after admission, thyroid function levels were assessed. Vancomycin, piperacillin-tazobactam, and doxycycline were empirically started.

J Cardiovasc Pharmacol. Contact afpserv aafp. However, the patient's temperature is not always an accurate diagnostic aid because some patients present with a normal temperature. Published online May

A chest X ray revealed cardiomegaly without evidence of congestive heart failure and also showed comx soft tissue deposition in the cervical region Figure 1A. Related articles in Google Scholar. Next: A Serpiginous Eruption on the Buttocks. Physicians should include hypothyroidism in the differential diagnosis of every patient with hyponatremia. It is considered an endocrinologic emergency that requires prompt attention and treatment. United States are considered to be risk factors for development of AIH [ 9 ].

However, myxedema coma is a misnomer because most patients exhibit neither the nonpitting edema known as myxedema nor coma. The dose of hydrocortisone was decreased to 50 mg intravenously every 8 h on day 3 and then to 25 mg intravenously every 8 h. A transcutaneous pacer was placed, raising his heart rate up to 70 bpm, but showed intermittent capture with an amplitude up to Address correspondence to Cristen R. Leading precipitating factors include stress, infection, and septicemia [ 910 ]. Conclusions Diagnosis of MC is difficult due to its various possible causes. Please review our privacy policy.

Fecal impaction. A — Comparison of chest X-rays at presentation with pre-treatment and last known normal chest X ray. Receive exclusive offers and updates from Oxford Academic. Based on initial observations, the differential diagnoses included MI, arrhythmia, hypoglycemia, electrolyte abnormality, renal failure, sepsis, pulmonary embolism, and hypothyroidism.

  • When there is doubt about a change in mental status, formal mental status testing should be performed.

  • Excess iodine also inhibits the entry of T4 to the peripheral tissue. Support Center Support Center.

  • Based on initial observations, the differential diagnoses included MI, arrhythmia, hypoglycemia, electrolyte abnormality, renal failure, sepsis, pulmonary embolism, and hypothyroidism. Arch Med Sci.

  • A transvenous pacer was ultimately avoided by the administration of isoproterenol. Journal List Cureus v.

  • The thyroid arm of the Framingham study showed that 5. Corresponding Author: Emily Zagorski, e-mail: gro.

If possible, pressors and font weight css w3c tutorial should be avoided because of their tendency to provoke arrhythmias in the setting of intravenous thyroid replacement. T4 levels were 0. The patient may then display the hypotension characteristically associated with myxedema coma. Articles from Cureus are provided here courtesy of Cureus Inc. The prognosis for patients with myxedema coma is difficult to define because of the small number of cases reported in the literature. Myxedema coma during long-term amiodarone therapy. National Center for Biotechnology InformationU.

Endocrinol Metab Clin North Am. Abdominal distension. The origin of the elevated activities of creatine kinase and other enzymes in the sera of patients with myxoedema. Am J Med. Article Contents Abstract. View Metrics. A diagnosis of myxedema coma was made based on her presentation and lab findings.

Singh BN. If these homeostatic mechanisms are overwhelmed by factors such as infection, the patient may decompensate into myxedema coma. Related articles in Google Scholar.

Patient had no previous history of thyroid surgery or radioiodine therapy. All images were taken in postero-anterior amiodarone induced myxedema coma hypothyroidism unless specified. Her past hypothyrokdism history was significant for Wegener's vasculitis, end stage renal disease on hemodialysis, paroxysmal atrial fibrillation, hypertension and obstructive sleep apnea. However, it became evident that the patient was hypothermic with a body temperature of About 3 h later, the patient was noted to be stuporous and non-verbalizing. Periorbital edema. We present here a patient with this rare complication of amiodarone therapy.

The clinical presentation can be non-specific; however, symptoms may include lethargy, hypothermia, psychosis, altered mental status, periorbital myxedsma, lid ptosis, macroglossia, bradycardia, decreased cardiac output, pericardial effusion, prolonged QTc, hypoventilation, hypercapnia, and respiratory failure, many of which are compounded into the myxedema coma score used in diagnosis [ 89 ]. The 24 hour excretion of iodine was mcg mcg. The patient concurrently had more common causes of acute encephalopathy, including uremia due to his poor baseline kidney function, infectious pneumonia, and hyponatremia. Dialysis was recommended for his acute kidney injury. Corresponding Author: Emily Zagorski, e-mail: gro. Endocr Pract.

Ann Intern Med. Read the full article. References 1.

Introduction Amiodarone is widely used as a rhythm-conversion agent in atrial fibrillation. Read the full article. Arch Med Sci. Work-up showed hypothermia, thyroid-stimulating hormone TSH of

Hypothyroidism mmyxedema hyperthyroidism in the elderly. Here, a case of amiodarone-induced MC in a year-old male is presented. Of note, the precipitating factor that leads to the development of MC, in this case, was systemic stress due to upper extremity cellulitis, indicated by a previous hospital admission. However, it became evident that the patient was hypothermic with a body temperature of An adrenocorticotropic hormone stimulation test can be administered if clinically warranted.

Arch Intern Med. Am J Med Sci. Significant nonpitting periorbital and lip edema without lower-extremity edema were noted. References: 1.

  • This article has been cited by other articles in PMC. Early-onset de novo hypothyroidism can emerge due to excessive iodine intake [ 5 ].

  • He received intravenous fluids, vasopressor therapy and stress dose steroids; he was intubated and admitted to the intensive care unit. Try out PMC Labs and tell us what you think.

  • The patient's temperature is usually less than

  • Amiodarone, an iodinated derivative of benzofuran which bears structural similarity to the thyroid hormones tri-iodothyronine T3 and tetra-iodothyronine thyroxine or T4can cause thyroid hypo- or hyperfunction.

Discussion It can be quite difficult to decipher the exact etiology of altered mental status in an older adult with multiple comorbidities. The aging process plays a significant hyopthyroidism in fluctuating levels of thyroid hormones, including thyroid-stimulating hormone TSHtriiodothyronine T3and thyroxine T4 [ 2 ]. Thyroid function in physiological aging and centenarians: Possible relationships with some nutritional markers. Even with previously normal thyroid function, amiodarone-induced myxedema coma should still be considered. Corresponding Author: Emily Zagorski, e-mail: gro. Publication types Case Reports. Computed tomography of the chest showed multifocal pneumonia.

Endocr Pract. After 3 days of treatment, the patient became arousable and was able to be extubated. Am J Med Sci. Substances Anti-Arrhythmia Agents Amiodarone.

Amiodarone-induced myxedema coma is a rare condition that has previously been amiodarrone in the literature less than 20 times since [ 9 — 11 ]. Myxedema coma induced by short-term amiodarone therapy. Myxedema coma is a rare cause of acute encephalopathy in older adults. Of note, thyroid function tests 2 years prior were normal.

New issue alert. While all patients with myxedema coma present with some degree of mental status change, few progress to coma. Hypothyroidism and hyperthyroidism in the elderly. She remained in sinus rhythm during her entire hospital stay. Pituitary involvement by Wegener's granulomatosis: a report of two cases.

The patient concurrently had more common causes of acute encephalopathy, including uremia due to his poor baseline kidney function, infectious pneumonia, tutorial hyponatremia. Antithyroid peroxidase was negative. Even with previously normal thyroid function, amiodarone-induced myxedema coma should still be considered. The thyroid arm of the Framingham study showed that 5. Unstable thyroid function in older adults is caused by alterations in both thyroid and pituitary physiology and is associated with increased mortality.

Antithyroid peroxidase was negative. The aging thyroid: thyroid deficiency in the Framingham Study. Extreme longevity is associated with increased serum thyrotropin. This response to thyroxine suggests that thyroxine itself may have biologic activity and participate directly in regulation of thyrotropin secretion. Successful treatment of myxedema coma with a combination of levothyroxine and liothyronine.

Endocr Pract. Amiodarone is known to cause both hyperthyroidism and hypothyroidism. Substances Anti-Arrhythmia Agents Amiodarone. Myxedema coma induced by short-term amiodarone therapy. A amiodarone induced myxedema coma hypothyroidism man with a past medical history of stage 5 chronic kidney disease, paroxysmal atrial fibrillation, on amiodarone mg twice daily for the last year, type 2 diabetes mellitus, and heart failure with reduced ejection fraction presented with multifocal pneumonia, acute kidney injury, and acute encephalopathy.

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