Hypothyroid coma: etiology, pathogenesis, clinical history. Hypothyroid coma - the extreme step of the badly treated hypothyroidism Causes of hypothyroid coma

hypothyroid coma- accelerated hypothyroidism, scho to rotate in a strong feasibility of all key manifestations deficiency of the thyroid gland, perspiration behind everything from the side of the central nervous system and heart-vascular system.

Hypothyroid coma is most often found in the sick of the kidnapped and old age, more often in women, less in choloviks.

Most often, a hypothyroid coma is susceptible to being charged, but it can be poured into low temperatures and more often colds(Pneumonia і t. D.) In the whole period of rock.

Ethiology and pathogenesis of hypothyroid Komi

Hypothyroid coma in ailments with important hypothyroidism in case of deficiency in lycuvania (noncautious hypothyroidism or lack of or irregular use of thyroid medications). Factors that make the development of the hypothyroid Komi, ignition processes in other organs - pneumonia and іn., lack of heart-vascular system, malignant swelling, etc.), physical trauma, surgical involvement, anesthesia, severe toxicity, lingering Lykarskiy rechovin(The introduction of large doses of barbiturates, aminazine, drugs, tranquilizers and in.).

Vvazayut, that the main pathogenetic factor in the development of the Komi State is the lack of thyroid hormones, which leads to a decrease in the metabolic processes in the brain, as a result of which there is a diagnosis of hypoxia. It was established that in case of hypothyroidism, there is increased confidence in cerebral blood circulation and reduction in the recovery of blood and glucose in the tissue brain. Defіtsit tireoїdnih gormonіv viklikaє torn down vsіh vidіv obmіnu: bіlkovogo (znizhennya synthesis rozpadu bіlka i) vuglevodnogo (pіdvischena toleration to vuglevodіv, skhilnіst to gіpoglіkemії) lіpіdnogo (zbіlshennya in krovі vmіstu alpha beta i i lіpoproteїdіv Especially cholesterol), water-solovogo (covering with water and sodium chloride in fabrics). Vvazhayut, the development of hypothyroidism in tissue tissue (generalized lymphedema) is accumulated with lymphostasis. Ridina (eksudat) accumulate in serous empty spaces. The presence of a great amount of birth in the empty pericardium to produce a tamponade of the heart (enlargement of the jugular veins with a paradoxical pulse, widening of the heart dullness, liver enlargement, etc.). As a result of a reduced salivation of acidity by organism and interstitial mass of the heart meat, there is a deterioration in the efficiency of the heart-vascular system (improvement between the heart, a change in sickness and blood circulation, circulatory volume)

In addition to galvanizing the activity of hypothalamic centers, a decrease in the activity of energetic exchange and impairment of peripheral blood flow, hypothermia is diagnosed. Damage to the function of vegetative nervous system(Imported її nice to see) I will summarize the functional destruction in the activity of small organs (bradycardia, decreased motor skills shlunkovo-intestinal tract, Zmenshene potovіlennya). Deterioration of the dichotomy with a slight hypercapnia, it is possible for the hyponatraemia and the growth of the brain to lead to drowsiness, soporosis and loss of quality (coma).

The main role in the pathogenesis of hypothyroid Komi is the lack of function of measles of supra-nirkovy zalosis, as well as the order of deficiency of thyroid hormones in the wake of a decrease in the adaptive powers of the organism.

Hypoventilation of the lungs, decreased organism and infections to produce pneumonia, catarrhal stumps of the upper dikhalnyh nobles... One of pathogenetic factors Hypothyroid Komi can be increased in the blood of ryvnya in carbon dioxide, which gives a toxic effect on the central nervous system.

clinika hypothyroid Komi

Clinically, hypothyroid coma manifests itself in severe deaths of a sick person. Most often, the comatose camp develops step by step.

To the provinces of the hipothyroid Komi There may be some onset symptoms: increased drowsiness and bradycardia, hypotonia, poorly responding to fresh sores, reduced and weakening of dysfunction, increased hypothermia, constipation, severe anxiety up to psychoses, sectional mikhura.

The development of the hypothyroid Komi has three phases: characterized by the trusting power of the brain, to the best and to whom. At the first phase, the certainty is sometimes lost. In the other phase of ailment, there is not a lot of disorientation, from time to time there is an uncomfortable stance, you can be judged. The third phase is characterized by a stiff second testimony, as in most ailments it is non-negotiable.

The triviality of the first two phases from decile years to month and more. In some cases, a hypothyroid coma is repaired for a raptus from a severe malady and razkogo fadinnya arterial vise.

Zovnishny viglyad the ailment is overly characteristic. The person is zhovtuvato-blide, puffy with a swell of povik, lips, shchik. In a number of cases, there is a swelling of the supraclavicular area, tilted surfaces of the hands and feet, etc. On the mind of those who are ill with hypothyroidism, there are no pits on the otoculated tissues. It’s worth tying it up, so that mucin accumulates in the main in the upper papillary balls of the shkiri. With widened swelling on the pidshkirnu! fatty cells, the fossa was forced to take on. Shkira tovsta, rough, cold on the dots, dry, peeling, bled with zhovtuvati, and in some oranges from the bottom (especially on the toes and feet), but the lack of blood flow and hyper-vascularity of A. stiffness to hemorrhage. hair on the head is dry, childish, lamina. A special thermometer with a scale, graduated below 35 ° C. pneumonia, etc.), swelling of heart failure, normal frequency of Olsen or navit tachycardia. Percussion refers to the expansion between the dullness of the heart, which is tied from a slow pace with the accumulation of sickness in the pericardium and myocardial changes ("myxedema-matous heart"). Tony is deaf. An arterial grip for a drop. Sinus bradycardia appears on the EKG, low voltage of the teeth, weak rotation of the T and P teeth, a decrease interval S-T lower izoelectric line, inversion of the T wave, increasing the interval P Q-

Dikhannya rіdke and weakened. Vinikak hypoxia and hypercapnia. As a result of mucinous changes of persuasion, one cannot cope with the mouth, but it can lead to the next retardation and complication of the work. Often the onset of constipation is simulated intestinal imperfection, but in a number of cases it can be brought to unprimed surgical procedures. In sick people, in sick people in hypothyroid comas, ascites is promoted, dressings accumulated in black empty mucinous genus and not absorbed by the intake of heart glucose and sechogenic diseases. As a result of the atony of the slaughter michur, the view of the slaughter is seen. Reflexive reduction. Increasing heart weakness and hypotonia lead to oliguria as far as anuria, acidosis, hypoxia, non-edentulous changes in the central nervous systems. In some of the ailments, there may be some mental damage to the type of hallucinatory-paranoid syndrome, which is similar to the type of depression.

For a critical interruption, the author develops the hyperthermic version of the Komi, the version of the Komi with the prevalence neurological damage, Variant of secondary supranational deficiency and manifestations of nirk deficiency. Naturally, such a development is cleverly possible, it can help the doctor in the differential diagnosis of the Komi and to make the necessary components of the solution possible.

Hyperthermic coma can be prevented with suppression of infections. The coma with the overhangs on the side of the central nervous system, imovirno, pummeled with a sharp swirling hypoxia and secondary congestion of the brain. In some cases, there is a pseudo-meningeal syndrome without changes in the spinal cord.

Laboratory data.Зміст СБЙ is significantly reduced. Characteristically, there is a growth in the change in blood T4 and Those with one-hour changes in the health of the TZG in the form of triiodothyronin (the coefficient is more than 1.13). Hypercholesterolemia is increased up to 25.8 mmol / l (1000 mg%) as a result of a decrease in metabolism and the appearance of cholesterol in the mouth. In a number of vipads, respiratory acidosis develops, as well as accumulation of hypoventilation. Instead of zukru in blood, grow up in the boundaries of norms, or even reductions, in rare cases of reductions, it is significant. You can spontaneous hyponatrimіya and hypercalієmіya. The level of chlorides in blood often decreases. Probably cautious.

Khvory N., 33 years old, enrolled at the clinic from the jabol thin weakness, Apathy, drowsiness, coldness, constipation, decreased appetite. We are sick of ourselves with a stretch of the remaining 2 rocky, if there is a weakness, badness, memory loss, puffiness of an individual, constipation (stiffness once every 3-4 dib), hoarseness of voice, homosexuals. Hypothyroidism was diagnosed, due to the induction of irregularly administered thyroid dosing. In the course of 1 month before the hospitalization, thyroidin has not been taken. As a result of the hospitable respiratory ailment, the camp has been significantly degraded (the mental weakness and drowsiness have endeavored), in the sound of which it has stood up.
With a proper fit, the zagalny camp is important. The ailment is very gagging, not showing interest until the next day. Drowsiness is swelling. Mova and the rukhs of trust. The person is puffed up (napryak povik, shchik, lips). The skin is dry, cold, the bleed is with a zhovtuvaty vidtinkom. The temperature was 35 ° С. The number of podikhiv 14 in khilina. Dyhannya vesicular, weakened. Pulse rіdkіsny, 50 in khilina, weak reminding. Arterial vise 12 / 6.6 kPa (90/50 mm Hg). Between the common dullness of the heart expanded to the left. Tony is deaf. At the EKG, the deterioration of the internal drainage capacity and the failure of the heart meat deterioration was determined. Mova of admiration, with teeth bits along the edges. Lives of children in the community. The pechinka is protruding from the edge of the costal arch by 2 cm, sore on palpation. The spleen is not bad. Pasternatsky's symptom is negative from both sides. Thyroid gland not bad. Dropsy ychok.
Blood analysis: er. 4.1 10``2 / l (4,100,000 in 1 μl), nb 130 g / l, l 5.8 109 / l, colline indicator 0.7, p. 6%, s. 58%, lymph. 39%, mon. 4%, f. 2%, SHOE 38 mm / year, SBY 78.8 mmol / L (1 μg%), cholesterol 6.9 mmol / L (270 mg%), zukor 3.99 mmol / l (72 mg%), excess nitrogen 28.6 mmol / l (40 mg%), bilirubin 5.1 mmol / l (0.3 mg%), prothrombin 71%, calium 7.6 mmol / l (7 , 6 meq / l), sodium 133 mmol / l (133 meq / l), calcium 2.1 mmol / l (4.2 mmol / l).
At the beginning of the clinical setting of the ailment, the diagnosis is made: hypothyroidism, important form; precomatose mill. Assigned treatment with triiodothyronine at 25 μg in the middle through the skin for 6 hours ( dobova dose 100 mcg), intravenous hydrocortisone, dropwise 50 mg 4 times per dose. Cocarboxylase (100 mg), 5 ml of 5% solution of ascorbic acid, 200 μg of vitamin B12, 1 ml of 5% solution of vitamin B6 were also administered intravenously.
Already, through the add-on of the performed lykuvannya the camp of the ailing one turned: arterial vise shifted to 14.8 kPa (105/65 mm Hg). Nadal stan prodovzhuvalo polіpshuvatisya. On the 25th day of writing for outpatient treatment.

Diagnostics and differential diagnosticshypothyroid Komi

Diagnosis of hypothyroid Komi is established on the presentation of a typical clinical picture of hypothyroidism and an unaccounted state, laboratory diagnostics.

A slid of differentiation from an insult, an infarction, a hypothalamic-hypophyseal, an uremic, a chloropenic and an eclamatic Komi, as well as from comatose stanovies, associated with a plant.

Forecast. Start fast diagnostics and therapy. Likuvannya needs to be repaired in the presence of precomi. It is very effective at temperatures not lower than 33 ° С. Lethality becomes 50%.

Prevention. The basis of prophylaxis is adequate and systematic substitution therapy that will provoke coma factors.

lykuvannya hypothyroid Komi

1. For the vivedennya of the sick from the hypothyroid Komi, put thyroid hormone in the first place. They give triiodothyronine, so as an ear of yogh (after 4 years) and the maximum effect (after 8-12 hours) comes faster, lower with vicorian thyroxine (an ear of thyroxine in 6-8 years, the maximum of yogh - after 7-10 days). We are sick without coronary lesions of triiodine-ronin hydrochloride is recognized in the middle, and if ailments are not kovtaє, inject 100-200 mcg through a slurry probe after 12 years, or 25 mcg after 4 hours. add. Inodi triiodothyronin is administered internally. At the same time, a special drug for parenteral administration is prescribed - levotriiodothyronin. With intravenous administration of triiodothyronin, it is necessary to administer 25 mcg of skin for 4 years until the temperature is adjusted and gradually reduce the dose to 50 mcg / day [Milku Sh., 1969]. When using thyroid hormones, control the pulse rate, dichannel, arterial grip, EKG and rectal temperature.

For internal administration of triiodothyronine tablets, it is dispensed in doses of 20 and 50 mcg, followed by a 0.1% solution of sodium bicarbonate, and then adding distilled water and 10% sodium chloride. The intravenous infusion solution is guilty of 30 mcg triiodothyronine per 100 ml. Introduce razchin speckled. Obshag yogo is not guilty of changing 100-200 ml. The initial dose of triiodothyronine is 150-200 mcg.

It is necessary to show maximum care when treating ailments with thyroid hormones ischemic ailment heart, so as with the high doses of iodine-ronin and especially with the intravenous injection, they may have a deterioration of the coronary blood flow, a heart failure, blinking arrhythmia and navit myocardial infarction. In cich vipadkah, take a larger dose of triiodothyronine (10-20 μg 2 times per dose). With a whole pochatkova dose of triiodothyronine, you should become 10 mcg 2 times for doba.

2. For the fight against collapse (supra-nirkoval zalosis), inject 100-200 mg of prednisolone intravenously, dropwise or hydrocortisone in a dose
200-400 mg. Nadal hydrocortisone is consumed internally at 50-100 mg of skin for 6 years until symptoms of collapse are detected (total dose of hydrocortisone is 300-400 mg), and then in smaller doses. Introduced rіdini should be surrounded by up to 500-1000 ml / add through the possibility of a quick development of heart-vascular insufficiency.

Preparations of sympathotonics (adrenaline, norepinephrine) we are ill in hypothyroid comas, they are contraindicated through the development of a heart-and-heart failure.

3. For prophylaxis and treatment of hypoglycemia, a drop of internal infusion of 5% glucose is prescribed.

4. For the improvement of oxidative processes, intravenously inject 100 mg of cocarboxylase, 5 ml of 5% ascorbic acid, 200 μg of vitamin B12, 1 ml of 5% of vitamin B6, ATP.

5. If there is a decrease in the volume of sodium and chloride in the blood, inject 10 ml of 10% sodium chloride solution internally.

6. To improve and improve infectious diseases(Pneumonia і etc.) Assume high doses of antibiotics wide rangeдії.

7.With the use of hypoxia and respiratory acidosis, carry out piece dikhannya... For polishing dikhannya zasosovuyut piece ventilation legends behind the aid of a respirator, priznachayuyu kisen.

8. Thermal procedures are not indicated, as it can ruin the blood circulation of the internal organs and can lead to the development of heart failure. Ailments are guilty of being overwhelmed at a temperature of 25 ° C far away from the heat. It is necessary to take care of the hygienic mind, so as to overcome the acceleration in the process of the treatment of the hypothyroid Komi.

The criteria for the effectiveness of the treatment are not only the sick person (indicators of the heart-vascular system - pulse, arterial vise, EKG, body temperature), albeit instead of thyrotropin in the blood, indicators of water-salt metabolism and in.

Potomkin V.V. non-slip sheets in the class of endocrine ailments, 1984 p

Hypothyroid coma is one of the most successful patients in accelerating hypothyroidism. Most often, you come to the children who suffer for hypothyroidism, in the abducted and old man, with a large number of women who are enemies. A coma develops in patients with an important overcoming of hypothyroidism, for a trivial hour they did not eliminate the necessary addiction, or they didn’t take it out of the way.

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Code for MKH-10

E03 Inshi form of hypothyroidism

Causes of the hypothyroid Komi

It’s uncommonly or inadequate to diagnose hypothyroidism in a large number of cases, it’s explained by the diagnostics of the disease. To improve the deficiency of hormones in the thyroid gland, it is also possible to prevent: the consumption of levothyroxine (for example, in patients with poor health), or as a result of a significant increase in the consumption of the organisms in the hormonal

through hypothermia;
through supportive illness (burning legends, infarction, insult, viral zvoryuvannya, Urogenital infection and in.);
through injuries, massive bleeding, prompt engagement, Exchange therapy;
when carrying out X-ray coverage;
taking medications to adjust the functions of the central nervous system;
as a result of taking a large dose of alcohol;
through hypoglycemia;
I'm going to become hypoxia.

The decrease in the level of thyroid hormones is reduced to a decrease in the activity of metabolic processes in the brain. In addition, there is a growth of hypoxia due to significant damage to all types in the exchange of speech and functions of large organs.

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Symptoms of hypothyroid Komi

The hypothyroid coma is generally progressive and growing. There are a number of times when there is a feeling of being overwhelmed, apathetic, far away, it is possible to promote the coldness of the pictures, the whiteness of the skins, the swelling and dryness of the feet. Years later, one will develop a spirit, fix problems with secular problems (right up to anuria), develop a lack of heart activity, lower blood pressure, and tendon reflexes disappear.

For an hour I will look around the ailing likar, I can brutalize respect for the offensive signs:

loss of processes of exchange of words (increase in blood flow, increase in blood circulation due to lower temperature indicators below 35 ° C);
the distribution of the functions of the heart-vascular system (control of the frequency of the heart, heart-like pulse, dropsy of the heart, lowering of the arterial grip);
damage from the side of the organs of energy (change in the number of vidikhiv-vidikhiv, change in blood pressure, timchasova zupinka dikhannya from the hour to sleep);
dysfunction of the nervous system (progressive stupor, loss of tendon reflexes);
dermatological symptoms (dryness, thinness and wax-like appearance, loss of hair and nigtiv, swelling of hyperkeratosis);
swirls of embryos on the face and kintsevkah, the fall of the soda in the blood;
an increase in anemia and symptoms associated with it;
hypoglycemia;
rosle herbal organs(Improvement of liver, development of dynamic intestinal obstruction).

Diagnostics of hypothyroid Komi

The symptomatology of hypothyroid Komi is characteristic, you don’t get too much information when you diagnose it, especially when you diagnose it, especially when it’s like a levothyroxin treatment, radioiodine therapy, and a thyroid disease.

Sometimes it is difficult to find out difficult diagnostics, but it is possible to be knitted from a foreign camp of patients, if there is no opportunity to conduct a second round and a few days of delay. The most frequent likar of temptations to start before the day inconvenient help until the results are reduced.

In rare cases, the clinical picture of a disease can appear atypical, it’s crazy, quicker setting up a diagnosis. For example, it can be seen as a key symptom, for example, a decrease in temperature or a vice infectious disease for a stiff hypertension.

Likuvannya gipothyroid Komi

Likuvannya of Komi is carried out in stages, in full in all directions.

Replacing hormonal treatment with glucocorticoids is the main method of patient therapy. Zazvychay priznachayut the second thyroid and glucocorticoid disorders, fixing the treatment with L-thyroxine, which is administered internally at 250 mg through the skin for 6 years. On a friend, Dobu carry out additional therapy in doses up to 100 mg / Dobu. The effect of L-thyroxine becomes thinner after a few years, so triiodothyronin in a dose of up to 50 mcg is added. Immediately zasosovyut prednisolone or hydrocortisone hemisuccinate. In addition, if the patient comes to the house, and the patient starts to turn, the glucocorticoid drugs will be taken.
Lіkuvannya hіpoglіkemiії is also an important stage for polіpshennya I will become ill, so as reduced to the norm the level of zukru in the blood will help to bring to the robot the brain, heart, sevidіnіy system. For the treatment of hypoglycemia, an internal injection of 20-30 ml of glucose dose (40%) and a drop of 500-1000 ml of glucose solution (5%) are used, for a general viscous control of blood pressure and severity.
Likuvannya deterioration of dyshal functions is an oblique stage of therapy, even dyhannya of patients in whom they become weak and childish. To get stuck in kisnevі іngalyatsії through nіs, and in important situations - piece ventilation lungs. If the patient’s stance has gone badly, then it’s necessary to inject internally up to 4 ml of cordiamina - a stimulator of dyshnoy function. If necessary, repeat 3-4 times if necessary, controlling the indicators of arterial vise.
Likuvannya porushenia from the side of the heart-vascular system, zokrem, reduction of the blood vice, is carried out from the stasis of rheopolyglyukin, 10% albumin. Vikoristannya sympathotonics in the region is not recommended, as it is possible to suffer from myocardial infarction in spite of thyroid problems. For the normalization of blood pressure indicators, drop Angiotensinamide, which is a peripheral vascular test. If a heart failure develops on the basis of a decrease in the arterial grip, then the introduction of heart problems, for example, a strophanthine, is vicious.
Normalization of temperature is even more important for a patient who has survived a thyrotoxic coma. For a cob of ailing slіd zіgrіti: for tsyogo more beautiful vicoristovuvati kovdri. It is not recommended to actively book for additional help. In the meantime, if the thyroid hormones are manifested, the temperature indicators are normalized.
Normalization of the picture of blood, the weakening of the anemia of the field in the transfusion of blood or erythrocytic mass, and such procedures can be carried out more than once. Dilution of anemia changes in tissue hypoxia to the body, including cerebral structures.

Unavoidable additional help in case of hypothyroidism

In case of hypothyroidism of a patient in the termine order, the hospital should be admitted to endocrinology or in reanimation.

It is not very helpful for the first year to carry out the term new administration of triiodothyronine in a quantity of 100 mcg. Dodatkovo priznachayut oxygen therapy. Intra-intravenously it is recommended to use hydrocortisone (100 mg), prednizolone (up to 50 mg), as well as the introduction of cardiovascular drugs.

After a half year, ATP is introduced, vitamini gr. B, razchin vitamin C (5% to 4 ml). Yakshcho indicators of systolic vise perevistiut 90 mm Hg. Art., vikoristovuyt introduced lasix. With a systolic vise less than 90 mm Hg. Art. vikoristovyt kordiamin, mezaton, corazol, heart preparations.

For 4 hours for the skin, to carry out a drop of triiodothyronine in a dose of 25 mcg (in case of myocardial ischemia or lack of heart activity - no more than 10 mcg of two per day). For normalization of temperature indicators and stabilization of the heart, the dose of triiodothyronine should be reduced very quickly. Continue oxygen therapy, sodium hydroxybutyrate victorian, passively improve the patient.

thyrotoxic coma It develops in individuals with important thyrotoxicosis on aphids of uncaptured thyrotoxic goiter, especially in the presence of important concomitant ailments and neuropsychic overexertion, as well as for prompt visualization of the thyroid area. The main Lankan pathogenesis є rіzke pіdvischennya instead of thyroid hormones in the blood, endotoxicosis, hypoxia, toxic damage to the nervous system (brain), cardiovascular system, liver, supernatant and other organs, disruption of the water-electrolyte balance. The development of the Komi before the thyrotoxic crisis. The sick person is susceptible to psychotic disturbance, it is not easy to suffer from maddens, hallucinations, tremors of kintsivok, as well as tachycardia (up to 180 - 200 in 1 min.), More perspiration, blues, oozing, 38 - fever. When there is adequate therapy, the sick person will go down: the skin is dry, the arterial grip decreases, the blinking arrhythmia, cyanosis, mediasis, bulbar discoloration (dysarthria, dysphagia, failure) develop. Reflexes are reduced, the meat tone is reduced, the secular tone is reduced, and the quality is reduced up to the Komi. Differential and diagnostic meaning may be given about the presence of thyrotoxicosis in the anamnesis, decreased mass, increased temperature, tachycardia, abnormalities, blues, profuse carry.

In the blood, there is an increase in the level of thyroid hormones tied with iodine, 17-hydroxyketosteroids, bilirubin (vnaslidok toxic lesion liver), metabolic acidosis.

Unavailable assistance turn on come in. Intra-intravenously inject 1 liter of isotonic sodium chloride, 5% glucose, 350 - 600 mg hydrocortisone, 120-180 mg prednisolone, 0.5-1 ml strophanthin K or corglikon, protisudomnі drugs (seduxen) mg per dobu). The term of hospitalization in endocrinology is shown.

hypothyroid comaє important acceleration of hypothyroidism. Most often it is possible to develop among individuals of a kidnapped person, since they did not discard treatment. A hypothyroid coma can also develop on aphids, malignant puffins, due to injuries or taking medications, to adjust the function of the brain. In the pathogenesis of the Komi, the main role is to reduce the communication processes in the brain, hypoxia to the brain on the basis of the lung hypoventilation with hypoxemia, hypochromic anemia, hope cerebral blood flow... Ear of deed. Hypothermia (temperature lower than 35 ° C), blindedness (with zhivtyanichnyy vidtіnkom) shkіrnyh curves, swelling wіk and cіntsіvok are indicated. Dikhannya Ridke, Surface. Bradycardia, arterial hypotension is promoted. Somehow it is the intertwining of evidence, then there are judgments, and stupor develops. Coma is often fatal.

When a person is ill, there is a decrease in the main metabolism, anemia, respiratory acidosis, an increase in SHOE, hypercholesterolemia, hypochloremia, a decrease in the level of thyroid hormones.

Unavailable assistance including carrying out onset... Intra-intravenously injecting thyroxine preparations in conjunction with glucocorticoids (100 - 300 mg hydrocortisone or 70-100 mg prednizolone). In case of sudomyas, 2 ml of seduxen should be injected internally. The sick need a term hospital in endocrinology or reanimation.

the appointment of the witness

Hypothyroid (myxedematous) coma is the terminal stage of important uncompensated hypothyroidism. Trapezya viklyuchno rіkko, the head rank among lіtnіh women in the cold season of fate.

cause sickness

The prevalence of adequate treatment for hypothyroidism in the main є inherited diagnostics, atypical clinical interruption. The loss of thyroid deficiency is also as a result of the use of a substitute therapy with levothyroxine (for example, in sick people who live in the minds of a lack of social awareness) and the growth of consumption of such factors in the city

hypothermia;

supporter hospri zhvoryuvannya(Pneumonia, myocardial infarction, stroke, viral infection, Urosepsis etc.);

trauma, bleeding, surgical involvement, exchanging therapy;

deyakі diagnostic procedures (for example, roentgenologic);

likarski zasobi, Yakі bring the central nervous system; alcoholic sp'yaninnya;

hypoglycemia;

hypoxia of any genesis.

Mechanisms of diagnosis and development of an illness (pathogenesis)

The pathogenesis of the hypothyroid Komi is foldable and rich in granularity. In any case, there will be a loss of all pathophysiological disorders characteristic of uncompensated hypothyroidism. At the asked viglyadі mova yde about such basic mechanisms.

Variations of thyroxine production deficiency should be naturally produced until the end of the intraclinic instead of triiodothyronin and, apparently, of the metabolic defects.

Hypometabolism in the central nervous system without interrupting the function, changing the mental state of the patient.

Decrease in thermogenesis and hypothermia decrease sensitivity nerve tissue up to hypercapnia and hypoxia with the development of dichal deficiencies, but in its own way there is even more disorganization of the clinical response in the central nervous system.

Hypometabolism of the myocardium is manifested by negative isotropic and chronotropic effects, loss of chilinous obscenity, development of heart failure on aphids of peripheral vascular support.

Decreased penetration of sudin and a syndrome of inadequate (overworldly) production of vasopressin impair the water-electrolyte balance. Tse lead to "water toxicity" (in the post-back space) and hyponatriyemia.

With the appearance of the disease, there is a lack of supra-nirkovy valleys, hypotension and hypotension occur.

Clinical picture of becoming ill (symptoms and syndromes)

A myxedema coma, as a rule, develops step by step on aphids of the typical hypothyroid symptomatology. There is a growth of malice, drowsiness, weakness, frostiness, whiteness, dryness and swelling of the skin, hypothermia. To admit brady, oliguria and anuria, heart failure, hypotension is swirling, tendon reflexes are known.

In the process of clinical patient care, it is possible to see the onset of the main syndromes:

hypometabolic (obesity, lowering the temperature below 35.5 ° C, and only 30 ° C);

heart-vascular damage (bradycardia, weakness in the pulse, low voltage of the teeth on the EKG, hydropericardium, depression of systolic arterial vise);

hypoventilation-hypercapnia (lowering the frequency dikhalnykh rukhiv, Hypoxemia, hypercapnia, respiratory acidosis, apnea syndrome);

impingement of the nervous system (build-up stupor, which step by step go into a coma, the development of tendon reflexes);

ectodermal breakdowns (dryness of the skin, waxy appearance, alopecia, lameness of hair and nigtiv, hyperkeratosis in dalyankas of small and colony loams);

nabryakliy (schilny nabryak denouncing and kintzivok, giponatrіemіya, mozhliv gostra zatrimka sechі);

anemic (hypochromic zalizodeficitny or macrocytic anemia);

lack of counterinsular hormones (hypoglycemia);

damage to organs of etching (hepatomegaly, megacolon, powerful development of dynamic intestinal imperfection).

diagnostics of illness

The development of the hypothyroid Komi is not a warehouse of special difficulties only with a typical classy paintings and clear anamnestic indications for replacement therapy with levothyroxine or postponed thyroid dectomy (resection of the thyroid gland) or radioiodine therapy. In some cases, the situation for the practitioner can be foldable. The head of the difficult diagnostics of a Komi species is tied to the severity of the backward camp of the ailments, to prevent problematic problems, and also because of the need for uncomplicated treatment, not for laboratory verification of hypothyroidism. Prior to that, there are some tests performed in the form of a typical classroom interruption, which will help to speed up diagnostics. There can be a presence of any kind of provincial signs, for example, hypothermia (in case of a separate infectious-ignition process), bradycardia (in case of swelling of the heart failure) or hypotensive

Provisions for additional information allow you to find out:

the value of a decrease in the concentration of fT4 і (f) T3, high TSH (in case of primary hypothyroidism);

anemia, hematocrit, leukopenia;

hypoglycemia, hyponatriyamia, hypercholesterolemia;

hypercapnia, respiratory acidosis;

cardiomegaly, hydropericardium, more - hydrothorax, ascites;

change in the amount of shchZ for the visibility in a typical place;

Decrease in syrovattsi level of cortisol.

Differential diagnosis. At the connection with the meanings of the difficult, you can know differential diagnosis hypothyroid Komi with low pathological stanov, zokrem:

nephrotic syndrome, chronic nirk deficiency;

grievous heart-vascular deficiency in walking, including myocardial infarction and cardiac tamponade;

encephalitis, damage to cerebral blood circulation;

intoxications;

mechanical intestinal imperfections;

hypocorticism, incl. second (on the ground of hypopituitarism).

lykuvannya zhvoryuvannya

conservatively

For those with critical conditions, the term of hospitalization of the sick is required in the form of intensive therapy. The drug program for hypothyroid coma includes such basic directions.

Substitution of therapy with thyroid hormone preparations: levothyroxine, dose 300-500 mcg i / v, at the beginning of the day - 50-100 mcg / dob i / v; if parenteral administration is uncomfortable nasogastric tube; lyothyronin in the first dose of 50 mcg of skin for 8 years through a nasogastric tube, on the beginning of the day - 50 mcg / day of skin for 12 years; However, the methodology, for deyakim data, supervises the growth of mortality. Treatment with thyroid hormone preparations during the control of the EKG, heart rate and heart rate, arterial pressure, temperature; for lіtnіkh patients for safety they repair lower doses. Zastosuvannya glucocorticoids (one hour with thyroid hormones anyway in front of them!): Hydrocortisone hemisuccinate 50-100 mg skin 6-8 years IV; prednizolone 15-30 mg skin 6-8 years intravenously.

At once positive dynamics, I will gradually change the dose of glucocorticoids. Fight against hypoventilation and hypoxia: niketamid (cordiamin) 2-4 ml of skin 6-8 years IV; іngalyatsіya zolozheniy sisnyu; piece ventilation of the legends (required in most cases before the renewal of the property). Correction of hypothermia. It is recommended to passively protect the sick person (at room temperature, not more than 25 ° C). Forsovane zigrivannya can destroy the camp of the patient!

Symptomatic therapy: injecting 40% glucose 20-40 ml intravenously with the correction of hypoglycemia, 5% glucose distribution intravenously, dropwise up to 1 l / dob; in times of critical anemia (concentration of hemoglobin less than 50 g / l) - transfusion of erythrocyte mass; in case of arterial hypertension, persh activate therapy with hydrocortisone, if necessary, administer Angiotensinamide in a dose of 4 mcg / hv intravenously in drops (vasoconstructions with a group of adrenergic drugs); with the method of induction dyuresu - furosemide 40-120 mg i / v; antibiotics of a wide range in therapeutic doses (navit during the daytime and various signs of an infectious-ignition process).

Forecast. Hypothyroid coma is one of the most critical conditions, as it is more important to drink. Unfortunately, the lethality reaches 40-60%; Prognostically unpleasant factors vvazayut abduction vik, Stike bradycardia and progressive hypothermia. Also, everything depends on the importance of prophylaxis and acceleration, the principle of simplicity and intelligence: early diagnosis of hypothyroidism and adequate supportive therapy for an hour.

Hypothyroid coma is an important stump, a legacy of decompensated. on early stage winy Increasingly, the growth of nig, the glory of the school and the cold in the cold. for more пізніх stage ailment consumes testimony, the grip falls and the pulse rises. For those who are hypothyroid, it is important to diagnose and seek additional help from thyroid medications, so that they can be used for updating the body. How it can be seen, how can it be inherited, is described in the article.

Hypothyroid coma - special features of the given stan

Myxedematous or hypothyroid coma was diagnosed in 1879 for the first time, and the development of the cases appeared in 1964.

Unimportant to the rapid development of medicine, the success of therapy does not depend on the correctness of diagnosis at the early stages.

Coma becomes inherited, accelerated by one of the forms of hypothyroidism, although often ailments suffer from ailments from the primary form of pathology.

Myxedematous who most often appear in young women and only in 0.1% of cases. Moreover, the statement of diagnosis can only be made for continuous reading.

Change your mind before development

The main reason for the development of the Komi is unhappiness for the change in dosage, or through different types of signs.

Before a group of people, there are mature women at the age of 50 years.

The main reasons for the hypothyroid Komi:

state of infection and ailments, such as an insult, an infarction, pathology legends, heart failure;
hypothermia;
internal bleeding;
there is a lot of blood loss through pooled operations;
problems with the exchange of speech, for example, hypoxia;
stress stun;
alcohol malice;
taking medications to adjust the nervous system;
trivial therapy with tranquilizers, barbiturates, lithium, diuretics.

Yak against the disease?

The key to the pathogenesis of pathology is the lack of food, through which the metabolic activity and sourness of the brain's hunger decrease.

Tse wede to such porosheni:

suffocation of blood circulation in the brain;
destruction of carbohydrate and lipid, water-salt exchange;
swelling of the brain structures through the accumulation of waste in empty spaces;
improvement between hearts;
damage to blood circulation.

It is necessary to accelerate the production to hypothermia, then to see the destruction of the robot and the vegetative system, and internal organizations work not in the new world.

dyshally lack of;
stuffed up the brain;
drowsiness;
pneumonia;
high level of carbon dioxide in the blood.

diagnostics of ailments

If you suspect that someone is hypothyroid, or if you have hypothyroidism, then the diagnosis will be clarified for more detailed information, which includes:

zagalny analysis of blood and slaughter;
analysis of plasmas for hormones;
cardiogram;
tomography;
x-ray;
MRI or CT scan of the organs of the heart-vascular system.

It is important to the nobility, when the presence of a state of decompensated hypothyroidism is evident, the diagnosis should begin to be navigated without further delay. Diagnostics is important for determining the stage and form of the SCC.

Vidi i formi komi

Є two scenarios for the development of a coma with hypothyroidism.

At the first drop, the dearth will begin to develop rapidly and unsupported, the vice and the heart will be inadequate.

In another, more extended version, the signs are more common. The Komi camp will not be seen all at once, but sometimes it will take up to two months. Everything you can look at from easy weakness and growth into an unaccountable camp.

Є All the stages of the hypothyroid Komi:

persha... There is drowsiness, bradycardia, weakness, drowsiness and may be judicious.
friend... It’s time to develop the robot of the central nervous system, it’s trivial to grow up to decile months. Pogershutsya reaction to sounds, light, temperature changes. Sleep is old and glib.
third(Before a coma). May be trivial until some days or even days. An hour from an hour ailments fall into an unseasonable camp, it may not turn out, the winter grows less, folds more collapses, becomes spontaneously sequential.
fourth stage... The coma itself, if the loss of testimony is of a persistent nature, there are no reactions to light and light, the brain’s power will be destroyed. The Danish country is non-negotiable and has a lethal result.