Hypothyroidism and Myxedema Coma

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Chief Compliant: The patient is a 50 year old white female with hypothyroidism who presents with weakness for 5 days.

History of the Present Illness: Fatigue, cold intolerance, constipation, weight gain or inability to lose weight, muscle weakness; thyroid swelling or mass; dyspnea on exertion; mental slowing, dry hair and skin, deepening of voice; carpal tunnel syndrome, amenorrhea. Somnolence, apathy, depression, paresthesias.

Myxedema madness: Agitation, disorientation, delusions, hallucinations, paranoia, restlessness, lethargy.

Factors Predisposing to Myxedema Coma. Cold exposure, infection, trauma, surgery, anesthesia, narcotics, phenothiazines, phenytoin, sedatives, propranolol, alcohol.

Past Medical History: Hyperthyroidism, thyroid testing, thyroid surgery.

Medications: Radioactive iodine treatment, antithyroid medication, lithium.

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