When is surgery indicated in the treatment of myxedema coma (crisis)?

Updated: Aug 31, 2020
  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Patients with myxedema coma who require surgical intervention are considered high risk for complications of anesthesia, as well as intraoperative and postoperative complications. Stabilization of these patients before proceeding to surgery is preferred unless the procedure is urgent.

In life-threatening situations, the loading dose of T4 and glucocorticoids are administered before induction of anesthesia. Careful administration of anesthetic agents with consideration of using lower doses should be exercised given the decreased metabolism of these agents in patients with myxedema coma.

Close monitoring during surgery and in the postoperative period in a critical care unit is imperative. Monitoring includes respiratory, cardiac, and volume and temperature status.

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