All right, so welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas and we're going to talk about mixadema coma.

And because Josh and I are chicken littles, of course, we're focusing on the most extreme

version of hypothyroidism.

So mixedema coma, as Josh said, decompensated hypothyroidism is the name of the game for today.

We'll talk about what patients you're going to see this in, how they present, what labs to get,

and of course, how are you going to treat it?

So let's get straight into it.

What is the epidemiology of the patient that shows in with either known hypothyroidism or more commonly

new diagnosis of mixed edema coma.

So overall, this is timely for a winter podcast because it happens more often during the winter

and more frequently in women in elderly patients, but it can occur in a variety of different

settings. And usually there's some sort of triggering physiologic stress that kicks this off.

It's kind of like DCA, thyroid storm, all of these endocrine things where folks kind of have

some simmering abnormality and then something kind of pushes them over the edge.

The suspects here are the typical ones, infection surgery, trauma burns, stroke, MI, GI

PLEED, cold intolerance, that's somewhat unique here.

Contrast eyes, various medications, sedatives, beta blockers, amioderone, and of course, checkpoint inhibitors.

Yay, they're coming back.

And the types of patients, female and elderly, very, very common.

And as Josh said, very, very common in the winter.

So you get the old 90-year-old woman who was found on the side of the street at 29 degrees. It's not just environmental hypothermia. It could also be

...