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Riedel's thyroiditis discovered at tracheostomy.

M G Spencer

    The Journal of Laryngology and Otology
    |January 1, 1985
    PubMed
    Summary
    This summary is machine-generated.

    A 55-year-old woman with diabetes experienced severe pneumonia and respiratory arrest. She was diagnosed with clinical myxedema, indicating hypothyroidism, which complicated her critical illness.

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    Area of Science:

    • Internal Medicine
    • Endocrinology
    • Critical Care Medicine

    Background:

    • A 55-year-old female with a history of diabetes mellitus presented with a two-day history of worsening cough, diarrhea, and anorexia.
    • Her condition rapidly deteriorated, leading to admission with symptoms suggestive of pneumonia.

    Observation:

    • Chest X-ray confirmed diffuse right-sided shadowing, indicative of pneumonia.
    • Despite antibiotic treatment, the patient suffered a respiratory arrest and required transfer to the Intensive Therapy Unit.
    • Clinical examination revealed myxedema, and thyroid function tests confirmed hypothyroidism with a low free thyroxine level.

    Findings:

    • The patient developed bilateral pneumonic changes and uncertain cerebral damage.
    • Thyroid function tests revealed a free thyroxine level of 0.4 pmol/L, indicating severe hypothyroidism.

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  • Elevated Erythrocyte Sedimentation Rate (ESR) of 54 mm/hr suggested significant inflammation.

    • Implications:

    • This case highlights the potential for severe hypothyroidism (myxedema) to complicate critical illnesses like pneumonia and respiratory failure.
    • Prompt recognition and management of endocrine dysfunction are crucial in critically ill patients.
    • The interplay between diabetes, severe infection, and thyroid dysfunction underscores the complexity of managing multi-morbid patients in intensive care settings.