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Myxoedema coma: response of thyroid hormones with oral and intravenous high-dose L-thyroxine treatment.

Abstract：

:Myxoedema coma is a medical emergency with high mortality. In this study, clinical response and plasma variations of thyroid hormones were analysed in 7 patients, 6 presenting with myxoedema coma and one with myxoedema ileus. These patients were treated with intravenous or oral l-thyroxine (l-T4). 1000 mu l-T4 iv were administered in two patients. Within 3 h, plasma T4 and triiodothyronine (T3) reached a peak upper normal range, then diminished slowly during 5-9 days. The 5 remaining patients were treated with 500 micrograms l-T4 po on the first day, then 100 micrograms l-T4 daily by mouth. Plasma T4 and T3 increased slowly, remaining in hypothyroid range but clinical response (assessed on mental status, pulse rate and body temperature) occurred within 24-72 h. Cortisone therapy was used in 3 patients. Two patients died of myocardial infarction, or septicemia, one while receiving cortisone therapy and i.v. l-T4, another one treated only by oral l-T4. This study suggests: 1) oral absorption of l-T4 is variable, but clinical response occurs quickly even in myxoedema ileus; 2) the intravenous route involves high peaks of plasma T4 and T3; 3) peripheral conversion of T4 to T3 allows gradually T3 delivery to organ systems, even if only l-T4 is used and 4) initial and daily dosage determinations need further studies.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Arlot S,Debussche X,Lalau JD,Mesmacque A,Tolani M,Quichaud J,Fournier A

doi

10.1007/BF01708403

subject

Has Abstract

pub_date

1991-01-01 00:00:00

pages

16-8

issue

1

eissn

0342-4642

issn

1432-1238

journal_volume

17

pub_type

杂志文章

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