Establishment of a Diagnostic Scoring System for Patients with Myxedema Coma

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 437-470-Non-neoplastic Thyroid Disorders
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-442
Geanina Popoveniuc*1, Tanu Chandra2, Meeta B Sharma3, Marc R Blackman4, Kenneth Burman5 and Leonard Wartofsky6
1Georgetown University Hospital, Alexandria, VA, 2George Washington University School of Medicine, Washington, DC, 3Washington Hosp Ctr, Washington, DC, 4Washington DC VAMC, Bethesda, MD, 5MedStar Washington Hospital Center, Washington, DC, 6Washington Hosp Center, Washington, DC
Intro:Myxedema coma (MC) represents a decompensated state of extreme hypothyroidism, with a high mortality rate if left untreated. The diagnosis of MC is clinical, and although it is generally accepted that diagnosis should rely on some degree of mental status alteration, impaired thermoregulatory response, and the presence of a precipitating event, clear cut diagnostic criteria to define MC have not been published.

Methods: We performed a retrospective analysis of all patients who presented to MedStar Washington Hospital Center, and the Veterans Affairs Medical Center, Washington DC from 1989 to 2009, with an admitting or discharge diagnosis of MC. The frequencies of various characteristics associated with myxedema coma were assessed and weighted, and used to derive a semiquantitative diagnostic scoring system to distinguish MC from severe hypothyroidism and uncomplicated hypothyroidism.We further assessed our diagnostic scoring system on selected patients reported in the literature. Statistical analysis was performed by using Microsoft excel spreadsheet software.

Results: We identified 21 cases, of whom only 14 were included in the analysis. The remaining 7 patients were excluded due either to lack of mental status alteration or biochemical evidence of clinical hypothyroidism. Our diagnostic scoring system included a composite of varying degrees of alterations of the following systems: thermoregulation, central nervous system, cardiovascular, gastrointestinal, and metabolic systems, and presence, or absence of a precipitating event. When applied to our 14 patients, a score of  ≥ 60 was found to be diagnostic of MC. Patients with less extreme hypothyroidism, including 6/7 of the patients excluded from the analysis had a score of 25 -50. When further applied to MC cases from the literature, 16/22 patients were identified as having a score of ≥ 60, while the other 6/22 achieved scores of 45-55. Importantly,  many of the patients evaluated from the literature were likely to have been “underscored” due to limited clinical data availability. Conceivably, an assigned score of ≥ 60 might have been achieved in those 6/22 patients with scores of 45-55, if one or two additional variables were present.

Conclusions: Based on our diagnostic scoring system, we propose that a score of  ≥ 60 is indicative of MC, that a score of 25–59 suggests risk for MC, and that a score < 25 is unlikely to represent MC. Use of this scoring system appears to have provided a useful reflection and index of the diagnostic features associated with MC in our cohort, and in patients assessed from published reports. Further prospective, controlled studies are needed to confirm the current findings, and to determine whether our proposed diagnostic scoring system will enable earlier recognition and more effective treatment of this endocrine emergency.

Nothing to Disclose: GP, TC, MBS, MRB, KB, LW

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