八、预后

八、预后

如果替代治疗不能快速、足量地应用,甲状腺功能减退性昏迷患者的预后较差,死亡率较高。文献记载,未应用替代治疗的死亡率是90%,给予替代治疗的死亡率是40%。影响预后的不利因素是体温<35℃及合并严重的并发症。

参考文献

[1] Mitchell,J.M.Thyroid disease in the emergency department:thyroid function tests and hypothyroidism and myxedema coma[J].Emerg Med Clin North Am,1989,7(4):885-902.

[2] Report of a committee of the Clinical Societ of London to investigate the subject of myxedema[J].Trans Clin Soc(Lond)(suppl)1888:21.

[3] Kudrjavcev,T.Neurologic complications of thyroid dysfunction[J].Adv Neurol,1978,19:619-636.

[4] Shaheen,M.Severe congestive heart failure patient on amiodarone presenting with myxedemic coma:a case report[J].Indian Heart J,2009,Jul-Aug,61(4):392-393.

[5] Barbesion G.Drugs affecting thyroid function[J].Thyroid,2010,20(7):763-770.

[6] Lazarus,J H.Lithium and thyroid[J].Best Pract Res Clin Endocrinology Metab,2009,23(6):723-733.

[7] Mannavola,D.A novel tyrosine-kinase selective inhibitor,sunitinib,induces transient hypothyroidism by blocking iodine uptake[J].J Clin Endocrinol Matab,2007,92(9):3531-3534.

[8] Nicoloff J T,LoPresti J S.Myxedema coma.A form of decompensated hypothyroidism[J].Endocrinol Metab Clin North Am,1993,22(2),279-290.

[9] Wilson Wr.Bedell G N.The pulmonary abnormalities in myxedema[J].J Clin Invest, 1960,39:42-55.

[10] Massumi R A,Winnacker J L.Sever depression of the respiratory center in myxedema[J].Am J Med,1964,36:876-882.

[11] Birring S S,Patel R B,Parker D,et al.Airway function and markers of airway inflammation in patients with treated hypothyroidism[J].Thorax,2005,60(3):249-253.

[12] Schenck J B,Rizvi A A,Lin T.Severe primary hypothyroidism manifesting with torsades depointes[J].Am J Med Sci ,2006,331(3),154-156.(https://www.daowen.com)

[13] Urquhart A D,Rea I M,Lawson L T,et al.A new complication of hypothyroid coma:neurogenic dysphagi a:presentation,diagnosis,and treatment[J].Thyroid,2001 Jun,11(6):595-598.

[14] Ji J S,Chae H S,Cho Ys,et al.Myxedema ascites:case report and literature review[J].J Korean Med Sci,2006,21(4),761-764.

[15] Chadha J S,Ashby D W,Cowan WK.Fatal intestinal atony in myxoedema[J].Brit Med J,1969,3(5667),398.

[16] Derubertis F R Jr,Michelis M F,Bloom ME,et al.Impaired water excretion in myxedema[J].Am J Med,1971,51(1),41-53.

[17] Sanders V.Neurologic manifestations of myxedema[J].N Engl J Med, 1962,22:599-603.

[18] Dutta P,Bhansali A,Masoodi S R,et al.Predictors of outcome in myxoedema coma:a study from a tertiary care centre[J].Critl Care,2008,12(1):R1.

[19] Wartofsky L,Burman K D.Alterations in thyroid function in patients with systemic illness:the “euthyroid sick syndrome” [J].Endocr Rev,1982,3(2):164-217.

[20] Mathes D D.Treatment of myxedema coma for emergency surgery[J].Anesth Analg,1998,86(2):450-451.

[21] Naidech A M,Paparello J,Leibiling S M,et al.Use of conivaptan(Vaprisol) for hyponatremic neuro-ICU patients[J].Neurocrit Care,2010,13(1):57-61.

[22] Ferguson-Myrthil N.Novel agents for the treatment of hyponatremia:a review of conivaptan and tolvaptan[J].Cardiol Rev,2010,18(6):313-321.

[23] Kwaku M P,Burman K D.Myxedema coma[J].J Intensive Care Med,2007,22(4):224-231.

[24] Jacqueline Jonklaas, Antonio C.Bianco, Andrew J.Bauer,et al.Guidelines for the Treatment of Hypothyroidism.American Thyroid Association[J].Thyroid,2014,12(24):1721.

[25] Bigos S T,Ridgway EC,Koutides I A,et al.Spectrum of pituitary alterations with mild and severe thyroid impairment[J].J Clin Endocinol Metab,1978 ,46(2):317-325.

[26] Kamilaris TC,DeBold CR,Pavlou S N,et al.Effect of altered thyroid hormone levels on hypothalamicpituitary-adrenal function[J].J Clin Endocinol Metab,1987,65(5),994-999.