Suspected Myxedematous Coma Essay

880 Words 4 Pages
April 14, 2014
Path Chart: 40 year old female with suspected myxedematous coma
Etiology/Risk Factors Structural/Physiological Alterations Clinical Manifestations/Complications
Etiology:
• Severe hypothyroidism with low levels of T3 and T4 hormones
Types:
• Primary: impairment of thyroid gland (No TH) o May be autoimmunity (Hashimoto thyroiditis), surgery (thyroidectomy), Iatrogenic (radioactive iodine ablation), congenital o Most common
• Secondary: impairment of pituitary gland (no TSH)
• Tertiary: impairment of hypothalamus (no TRH)
• Subclinical: No manifestations
Risk Factors:
• People with history of chronic hypothyroidism
• Iodine deficiency o Iodine component in creation of thyroid
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, pituitary, or hypothalamus

Decrease T3 in cells and T4 in serum (high TSH)

Inefficient use of energy/ATP

Decrease in basal metabolic rate

Affects cardiovascular, respiratory, CNS, urinary, GI, integumentary, endocrine, muscular, and reproductive system

Cardiovascular decreased heart beat

low muscle contractility

low cardiac output (<5L/minute)

decreased blood flow + low blood pressure → vasoconstriction

decreased glucose metabolism

Respiratory & CNS desensitized CNS detection of O2 & CO2 abundance

alveolar hypoventilation

hypoxia: low O2 & hypercapnia: high CO2

Urinary
Low GFR

Low sodium absorption

not able to excrete extra water + waste

buildup of hydrophilic mucopolysaccharide substance like glycosaminoglycans, hyaluronic acid

generalized nonpitting edema

GI & Muscles
Decrease in T3+T4 hormones

Lower rate of RNA transcription

Decrease in synthesis of protein & enzymes

decrease synthesis rate of ATP/calories

low amount of ATP and energy

decrease in exothermic reaction (heat)

vasoconstriction of vessels

Reproductive
Disrupted transformation of estrogen precursor to estrogen

Impaired secretion of luteinizing + follicle-stimulating hormones

Ovulation cycle varies
︎↙︎ ↘︎︎︎ no ovulation short, heavy menstruation

Endocrine
Decreased levels of T3+T4

Negative Feedback loop: tissues will signal to hypothalamus

TRH secreted

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