{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:54:00Z","timestamp":1791608040564,"version":"4.3.4"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2008,1,3]],"date-time":"2008-01-03T00:00:00Z","timestamp":1199318400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2008,1,3]],"date-time":"2008-01-03T00:00:00Z","timestamp":1199318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Background<\/jats:title>\n                        <jats:p>With the easy availability of thyroid hormone assays, thyroid disorders are now recognised even in a subclinical state. However, patients are still seen with advanced manifestations of the disease, particularly in developing countries. This observational study analysed the predictors of outcome in patients with myxoedema coma and tested the validity of different modules to define morbidity and mortality in these patients.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>Twenty-three consecutive patients with myxoedema coma who presented from January 1999 to August 2006 were studied. The thyroid function test and random serum cortisol were measured in all patients at the time of admission. Patients were given oral or intravenous (IV) thyroxine with intention to treat with the latter according to availability. Various modules that predict outcome, including Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score, were analysed. SOFA score was repeated every 2 days until the time of discharge or demise.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>Twenty-three patients (20 women; 87%) of 59.5 \u00b1 14.4 years of age (range, 30 to 89 years) were seen during the study period. Nine (39%) patients were diagnosed with hypothyroidism for the first time at the time of presentation of myxoedema coma, whereas 14 (70%) were diagnosed with hypothyroidism previously. However, the treatment defaulters presented early to the hospital and had more severe manifestations than <jats:italic>de novo<\/jats:italic> subjects. Nineteen (82%) had thyroprivic (primary) and 4 (17%) had trophoprivic (secondary) hypothyroidism. Fifteen (65%) patients presented in the winter and in 17 (74%) sepsis was the major accompanying comorbidity. Twelve (52%) had a history of diuretic use, thereby delaying the initial diagnosis. Patients who received oral L-thyroxine had no difference in outcome from those receiving IV thyroxine. Twelve (52%) subjects died and sepsis was the predominant cause of death. Various predictors of mortality included hypotension (<jats:italic>p<\/jats:italic> = 0.01) and bradycardia (<jats:italic>p<\/jats:italic> = 0.03) at presentation, need for mechanical ventilation (<jats:italic>p<\/jats:italic> = 0.00), hypothermia unresponsive to treatment (<jats:italic>p<\/jats:italic> = 0.01), sepsis (<jats:italic>p<\/jats:italic> = 0.01), intake of sedative drugs (<jats:italic>p<\/jats:italic> = 0.02), lower GCS (<jats:italic>p<\/jats:italic> = 0.03), high APACHE II score (<jats:italic>p<\/jats:italic> = 0.04), and high SOFA score (<jats:italic>p<\/jats:italic> = 0.00). However, SOFA score was more effective than other predictive models as baseline and day 3 SOFA scores of more than 6 were highly predictive of poor outcome.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusion<\/jats:title>\n                        <jats:p>L-Thyroxine treatment defaulters had more severe manifestations compared with <jats:italic>de novo<\/jats:italic> subjects. Outcome was not influenced by either aetiology or route of administration of L-thyroxine, and SOFA score was the best outcome predictor model.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/cc6211","type":"journal-article","created":{"date-parts":[[2012,5,14]],"date-time":"2012-05-14T14:31:49Z","timestamp":1337005909000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":115,"title":["Predictors of outcome in myxoedema coma: a study from a tertiary care centre"],"prefix":"10.1186","volume":"12","author":[{"given":"Pinaki","family":"Dutta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Bhansali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shriq Rashid","family":"Masoodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Bhadada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneet","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Rajput","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2008,1,3]]},"reference":[{"key":"5644_CR1","first-page":"2485","volume":"62","author":"CR Wall","year":"2000","unstructured":"Wall CR: Myxoedema coma: diagnosis and treatment.\n                           Am Fam Physi 2000, 62: 2485-2490.","journal-title":"Am Fam Physi"},{"key":"5644_CR2","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/0736-4679(90)90390-H","volume":"8","author":"R Santiago","year":"1990","unstructured":"Santiago R, Rashkin MC: Lithium toxicity and myxoedema coma in an elderly woman.\n                           J Emerg Med 1990, 8: 63-66. 10.1016\/0736-4679(90)90390-H","journal-title":"J Emerg Med"},{"key":"5644_CR3","first-page":"103","volume":"44","author":"JC Galofr\u00e9","year":"1997","unstructured":"Galofr\u00e9 JC, Garc\u00eda-Mayor RV: Densidad de incidencia del coma mixedematoso.\n                           Endocrinologia 1997, 44: 103-104.","journal-title":"Endocrinologia"},{"key":"5644_CR4","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/j.ecl.2006.09.003","volume":"35","author":"L Wartofsky","year":"2006","unstructured":"Wartofsky L: Myxoedema coma.\n                           Endocrinol Metab Clin N Am 2006, 35: 687-698. 10.1016\/j.ecl.2006.09.003","journal-title":"Endocrinol Metab Clin N Am"},{"key":"5644_CR5","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1677\/joe.0.1800347","volume":"180","author":"I Rodr\u00edguez","year":"2004","unstructured":"Rodr\u00edguez I, Fluiters E, P\u00e9rez-M\u00e9ndez LF, Luna R, P\u00e1ramo C, Garc\u00eda-Mayor RV: Factors associated with mortality with myxoedema coma: prospective study in 11 cases treated in a single institution.\n                           J Endocrinol 2004, 180: 347-350. 10.1677\/joe.0.1800347","journal-title":"J Endocrinol"},{"key":"5644_CR6","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1089\/thy.1999.9.1167","volume":"9","author":"T Yammamoto","year":"1999","unstructured":"Yammamoto T, Fukuyama J, Fujoysh A: Factors associated with mortality of myxoedema coma.\n                           Thyroid 1999, 9: 1167-1174.","journal-title":"Thyroid"},{"key":"5644_CR7","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/BF02938083","volume":"148","author":"MJ Cullen","year":"1979","unstructured":"Cullen MJ, Mayne PD, Sliney I: Myxoedema coma.\n                           Ir J Med Sci 1979, 148: 201-206.","journal-title":"Ir J Med Sci"},{"key":"5644_CR8","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1007\/BF03044925","volume":"92","author":"W Reinhardt","year":"1997","unstructured":"Reinhardt W, Mann K: Incidence, clinical picture and treatment of hypothyroid coma: results of a survey.\n                           Med Klin 1997, 92: 521-524.","journal-title":"Med Klin"},{"key":"5644_CR9","doi-asserted-by":"publisher","first-page":"3725","DOI":"10.1210\/jc.2006-0674","volume":"91","author":"BM Arafah","year":"2006","unstructured":"Arafah BM: Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods.\n                           J Clin Endocrinol Metab 2006, 91: 3725-3745. 10.1210\/jc.2006-0674","journal-title":"J Clin Endocrinol Metab"},{"key":"5644_CR10","unstructured":"Larsen K, Melmed P: Central hypothyroidsim. In Williams Textbook of Endocrinology. 10th edition. 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