An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of:
A. Thyroid storm.
B. Cretinism.
C. Myxedema coma.
D. Hashimoto’s thyroiditis.
Correct Answer: C. Myxedema coma.
Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Patients are most commonly presenting for emergency services with altered mental status and hypothermia, below 35.5 degrees C (95.9 degrees F). The lower the body temperature, the worst is the prognosis. The absence of mild diastolic hypertension in severely hypothyroid patients is a warning sign of impending myxedema coma.
Option A: Thyroid storm is an acute complication of hyperthyroidism. Thyroid storm, also known as thyrotoxic crisis, is an acute, life-threatening complication of hyperthyroidism. It is an exaggerated presentation of thyrotoxicosis. It comes with sudden multisystem involvement.
Option B: Cretinism is a form of hypothyroidism that occurs in infants. Congenital hypothyroidism (CH) is defined as thyroid hormone deficiency present at birth. CH must be diagnosed promptly because delay in treatment can lead to irreversible neurological deficits. Before the newborn screening program, CH was one of the most common preventable causes of intellectual disability.
Option D: Hashimoto’s thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role. Hashimoto thyroiditis is an autoimmune disease that destroys thyroid cells by cell and antibody-mediated immune processes. It is the most common cause of hypothyroidism in developed countries. This disease is also known as chronic autoimmune thyroiditis and chronic lymphocytic thyroiditis. The pathology of the disease involves the formation of antithyroid antibodies that attack the thyroid tissue, causing progressive fibrosis.
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