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Die thyreotoxische Krise und das Myxödemkoma

Thyrotoxic crisis and myxedema

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Intensivmedizin und Notfallmedizin

Summary

Thyroid storm can develop in patients with longstanding hyperthyroidism. Precipitating factors are infections, surgery or iodine contamination. Three major features usually predominate: fever, tachycardia, and CNS dysfunction. Suppressed serum TSH and elevated free T4 levels confirm the diagnosis. Thyrotoxic crisis requires rapid institution of immediate therapy with antithyroid drugs. The hypermetabolic state can be reduced with betablockers. Treatment in an intensive care unit is essential. Myxedema coma represents another endocrine emergency. The patients have a prior history of untreated hypothyroidism. Common precipitating factors include infection or drugs. The typical clinical features are hypothermia, bradycardia and neuropsychiatric manifestations such as lethargy. Diagnosis should be confirmed by measurement of serum TSH and free T4. Thyroid hormone therapy should initially be aggressive (high dose T4 or T3 i.v.) under close monitoring since arrhythmias or myocardial infarction are frequent complications of myxedema coma and its treatment with thyroid hormones.

Zusammenfassung

Die thyreotoxische Krise entwickelt sich aus einer vorbestehenden schweren Hyperthyreose. Die Dekompensation der Hyperthyreose wird meist durch bestimmte Faktoren wie Infektionen, Operationen und insbesondere eine Jodkontamination ausgelöst. Leitsymptome sind Fieber, Tachykardie und eine zentralnervöse Symptomatik. Die laborchemische Diagnostik mit einem supprimierten TSH und in aller Regel erhöhten FT4-Spiegeln bestätigt die Diagnose. Die thyreotoxische Krise erfordert eine rasche Therapieeinleitung mit hochdosierten Thyreostatika und unbedingt eine intensivmedizinische Überwachung. Der hypermetabole Zustand muss durch β-Blocker reduziert werden. Das Myxödemkoma stellt ebenfalls einen endokrinologischen Notfall dar. Auch diese Erkrankung entwickelt sich durch auslösende Faktoren (Infektionen, Medikamente) aus einer vorbestehenden Hypothyreose. Das klinische Bild beinhaltet Hypothermie, Bradykardie und eine zentralnervöse Symptomatik mit Lethargie. Die Diagnose wird durch Bestimmung von TSH und FT4 gesichert. Die Therapie besteht in einer parenteralen Schilddrüsenhormonsubstitutionstherapie, die unmittelbar nach Diagnosestellung begonnen werden muss. Darunter sollten die Patienten engmaschig intensivmedizinisch überwacht werden.

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin I, Universität Regensburg, 93042, Regensburg, Germany

    S. Zierhut & C. Girlich

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  1. S. Zierhut
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  2. C. Girlich
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Correspondence to S. Zierhut.

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Serie: Die Notfall- und Intensivtherapie bei endokrinen und metabolischen Erkrankungen Herausgegeben von J. Schölmerich und Ulrike Woenckhaus (Regensburg)

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Zierhut, S., Girlich, C. Die thyreotoxische Krise und das Myxödemkoma. Intensivmed 41, 573–582 (2004). https://doi.org/10.1007/s00390-004-0520-6

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  • DOI: https://doi.org/10.1007/s00390-004-0520-6

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