Die thyreotoxische Krise und das Myxödem-Koma sind seltene, äußerst lebensbedrohliche
endokrinologische Notfälle. Beide Zustände erfordern eine rasche klinische Diagnose
und intensivmedizinische Therapie. Die thyreotoxische Krise ist durch einen Hypermetabolismus
gekennzeichnet – das Myxödem-Koma durch einen hypometabolen Zustand. Beide entstehen
durch Dekompensation einer Schilddrüsen-Erkrankung unter Einfluss auslösender Faktoren,
deren Identifikation und Behandlung essenziell sind.
Abstract
Thyrotoxic crisis and myxedema coma are rare but highly life-threatening endocrinological
emergencies. Both conditions require rapid clinical diagnosis and intensive care treatment,
as mortality remains high despite treatment (up to 30% in thyrotoxic crisis, up to
60% in myxedema coma). While thyrotoxic crisis is characterized by hypermetabolism
with fever, tachycardia, agitation, and multiorgan failure, myxedema coma manifests
as a hypometabolic state with hypothermia, bradycardia, impaired consciousness, and
respiratory failure. Diagnosis is primarily based on the clinical picture; laboratory
findings should not delay initiation of treatment. Both emergencies usually arise
from decompensation of a known thyroid disorder under the influence of precipitating
factors, the identification and treatment of which are essential. Treatment for thyrotoxic
crisis includes the simultaneous administration of beta-blockers, high-dose antithyroid
drugs, glucocorticoids, and intensive care support. In myxedema coma, immediate intravenous
hormone replacement (L-thyroxine) and hydrocortisone administration are paramount.
Interdisciplinary care and consistent follow-up treatment of the underlying disease
are crucial for the prognosis.
Schlüsselwörter
Myxödem - thyreotoxische Krise - Schilddrüse - Notfall
Keywords
Myxedema - thyreotoxic storm - emergency - thyroidea
