Document Detail

Early recognition of myxedematous respiratory failure in the elderly.
MedLine Citation:
PMID:  19371530     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To report the clinical characteristics of myxedematous respiratory failure in the elderly and to facilitate early recognition of hypothyroidism in critically ill old patients. METHODS: Clinical characteristics of our reported 4 patients and that of 17 patients with myxedematous respiratory failure reported previously were reviewed. Demographic information, vital signs, basic laboratory studies, and blood gas analysis were compared. RESULTS: All 4 patients were older than 60 years and were hypoxic and hypercarbic upon presentation. All were found to have either anemia or marked electrolyte abnormalities and markedly elevated levels of thyroid-stimulating hormone once these levels were evaluated. Three of the 4 patients presented with profound lethargy and/or constipation, slowed intellectual ability, and dry skin. CONCLUSIONS: Early recognition of hypothyroidism in elderly patients with myxedematous respiratory failure is crucial to prognosis. Whereas hypothermia, myxedema, and a history of thyroid disease mandate the thyroid function tests in patients with type 2 respiratory failure, the following 5 elements also warrant the thyroid function tests: bradycardia, anemia, hyponatremia, pleural or pericardial effusion, and a history of weight gain. Where mechanical ventilation has been applied, patients with difficult weaning from ventilator support should also be evaluated and screened for hypothyroidism.
Fuping Guo; Tengda Xu; Houli Wang
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  27     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-04-17     Completed Date:  2009-05-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  212-5     Citation Subset:  IM    
Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Tsinghua University, Beijing 100730, PR China.
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MeSH Terms
Aged, 80 and over
Blood Gas Analysis
Diagnosis, Differential
Early Diagnosis
Hypothyroidism / diagnosis*
Middle Aged
Myxedema / diagnosis*
Respiratory Insufficiency / diagnosis*

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