What are the potential complications of an untreated sinus infection. How can a sinus infection affect your sense of smell. Can a sinus infection lead to breathing difficulties. What is the link between sinusitis and laryngitis. How can a sinus infection impact your eyes and vision. Is there a connection between sinus infections and brain-related complications.

The Hidden Dangers of Neglecting Sinus Infections

Sinus infections, while often considered a minor inconvenience, can lead to severe complications if left untreated. Many individuals underestimate the potential risks associated with prolonged sinusitis, assuming it will resolve on its own. However, the proximity of sinuses to vital organs like the brain and eyes makes untreated infections a serious concern.

Understanding the potential consequences of neglecting sinus infections is crucial for maintaining overall health and preventing more severe conditions. Let’s explore the various complications that can arise from untreated sinusitis and why seeking timely medical attention is essential.

Impact on Olfactory Function: When Sinusitis Affects Your Sense of Smell

One of the most common yet often overlooked complications of untreated sinus infections is the impact on our sense of smell. Anosmia, or the loss of smell, can occur due to prolonged inflammation and blockage of nasal passages or damage to the olfactory nerve.

How does sinusitis lead to anosmia? The infection causes swelling in the nasal passages, preventing odor molecules from reaching the olfactory receptors. In severe cases, the inflammation can even damage the delicate nerve endings responsible for detecting smells.

While the loss of smell is often temporary, severe or chronic sinusitis can result in permanent anosmia. This condition can significantly affect quality of life, impacting taste perception and potentially posing safety risks, such as the inability to detect smoke or gas leaks.

Recovering Your Sense of Smell

• Seek prompt treatment for sinus infections
• Use saline nasal rinses to clear congestion
• Consider olfactory training exercises
• Consult an ENT specialist for persistent issues

Breathing Difficulties: When Sinusitis Obstructs Your Airways

Untreated sinus infections can lead to significant breathing difficulties, impacting daily life and overall health. The inflammation and congestion associated with sinusitis can make it challenging to breathe through the nose, forcing individuals to resort to mouth breathing.

Why does sinusitis cause breathing problems? The infection causes the sinus cavities to become inflamed and filled with mucus, blocking the nasal passages. This obstruction not only makes it difficult to breathe but can also lead to fatigue due to reduced oxygen intake.

Chronic mouth breathing resulting from sinus infections can lead to additional complications, including dry mouth, bad breath, and an increased risk of dental problems. It’s essential to address these breathing difficulties promptly to prevent long-term issues.

Strategies to Improve Breathing During Sinusitis

1. Use a humidifier to moisten the air
2. Elevate your head while sleeping
3. Try nasal strips or dilators
4. Perform nasal irrigation with saline solution
5. Avoid irritants like smoke and strong odors

From Sinuses to Voice Box: The Connection Between Sinusitis and Laryngitis

An often-overlooked complication of untreated sinus infections is the development of laryngitis, an inflammation of the voice box or larynx. This condition can significantly impact vocal quality and communication abilities.

How does a sinus infection lead to laryngitis? When sinusitis goes untreated, the excess mucus produced drips down the back of the throat in a process known as post-nasal drip. This constant irritation can inflame the larynx, resulting in hoarseness, dry cough, and sometimes even temporary loss of voice.

The link between sinusitis and laryngitis highlights the interconnected nature of our upper respiratory system. Addressing sinus infections promptly can help prevent this cascade of symptoms and protect vocal health.

Caring for Your Voice During Sinusitis

• Stay hydrated to thin mucus secretions
• Avoid clearing your throat excessively
• Use steam inhalation to soothe irritated tissues
• Rest your voice when experiencing hoarseness
• Consider using a throat lozenge to lubricate the throat

Ocular Complications: When Sinus Infections Affect Your Eyes

The close proximity of the sinuses to the eyes means that untreated sinus infections can lead to several ocular complications. Two significant conditions that can arise are dacryocystitis and orbital cellulitis, both of which require prompt medical attention.

Dacryocystitis is an inflammation or infection of the tear sac, often resulting from a blockage in the tear duct. Chronic sinusitis can contribute to this condition by causing inflammation in the surrounding tissues. Symptoms include tearing, pain, redness, and swelling in the inner corner of the affected eye.

Orbital cellulitis, a more severe complication, involves inflammation or infection of the eye socket. This condition can arise from the direct spread of a sinus infection, particularly from the ethmoid sinuses located between the nose and eyes. Orbital cellulitis is a medical emergency that can threaten both vision and life if left untreated.

Recognizing Eye-Related Complications of Sinusitis

• Excessive tearing or discharge from the eye
• Pain or pressure around the eyes
• Redness and swelling of the eyelid or surrounding area
• Changes in vision or eye movement
• Fever accompanying eye symptoms

If you experience any of these symptoms in conjunction with a sinus infection, seek immediate medical attention to prevent potential vision loss or more serious complications.

The Brain-Sinus Connection: Neurological Risks of Untreated Sinusitis

Perhaps the most alarming potential complications of untreated sinus infections are those affecting the brain. While rare, these conditions can be life-threatening and require immediate medical intervention.

Cavernous sinus thrombosis is a serious condition where a blood clot forms in the cavernous sinus, a cavity at the base of the brain. This can occur when a sinus infection spreads to the brain. Symptoms include severe headaches, facial pain, high fever, and vision problems.

Meningitis, an inflammation of the protective membranes covering the brain and spinal cord, is another potential complication of untreated sinusitis. It presents with symptoms such as high fever, severe headache, neck stiffness, and sensitivity to light.

Warning Signs of Neurological Complications

1. Sudden, severe headache that worsens over time
2. High fever accompanied by neurological symptoms
3. Changes in vision or eye movement
4. Neck stiffness or pain
5. Confusion or altered mental state
6. Seizures

These symptoms, especially when occurring alongside a sinus infection, warrant immediate emergency medical care. Early diagnosis and treatment are crucial in preventing long-term neurological damage or potentially fatal outcomes.

Prevention and Early Intervention: Safeguarding Against Sinus Infection Complications

Given the potential severity of complications arising from untreated sinus infections, prevention and early intervention are key. Understanding how to manage sinus health and recognize the signs of infection can help avoid these serious risks.

How can you prevent sinus infections? Maintaining good nasal hygiene, staying hydrated, and avoiding known irritants can help keep your sinuses healthy. Regular use of saline nasal rinses can also help clear mucus and allergens from the nasal passages.

When should you seek medical attention for a sinus infection? If symptoms persist for more than 10 days, worsen after initial improvement, or are accompanied by high fever or severe pain, it’s time to consult a healthcare provider. Additionally, individuals with recurring sinus infections should seek evaluation to address any underlying causes.

Strategies for Maintaining Sinus Health

• Practice good hand hygiene to prevent viral infections
• Use a humidifier to keep nasal passages moist
• Avoid known allergens and irritants
• Quit smoking and avoid secondhand smoke
• Manage allergies effectively
• Stay up-to-date with vaccinations, including flu shots

By prioritizing sinus health and seeking timely treatment for infections, you can significantly reduce the risk of developing these potentially serious complications. Remember, while most sinus infections resolve on their own, it’s crucial to be vigilant and proactive in monitoring your symptoms and overall health.

Comprehensive Care: Treating Sinus Infections and Their Complications

When faced with a sinus infection or its complications, a multifaceted approach to treatment is often necessary. The specific treatment plan will depend on the severity of the infection and any resulting complications.

For uncomplicated sinus infections, treatment may include:

• Nasal decongestant sprays or drops
• Oral decongestants
• Nasal corticosteroids
• Saline nasal irrigation
• Antibiotics (for bacterial infections)

In cases where complications have developed, more aggressive treatments may be required. These can include:

1. Intravenous antibiotics for severe infections
2. Surgical drainage for abscesses
3. Endoscopic sinus surgery for chronic or recurrent sinusitis
4. Specialized treatments for specific complications (e.g., anticoagulants for cavernous sinus thrombosis)

How long does it take to recover from a sinus infection and its complications? Recovery time can vary greatly depending on the severity of the infection and any resulting complications. Uncomplicated sinusitis may resolve in 7-10 days with appropriate treatment, while more severe cases or those with complications may require weeks or even months of recovery.

The Role of Specialists in Treating Sinus Complications

Depending on the nature and severity of sinus infection complications, various specialists may be involved in your care:

• Otolaryngologists (ENT specialists) for sinus and ear-related issues
• Ophthalmologists for eye-related complications
• Neurologists for brain-related complications
• Infectious disease specialists for severe or resistant infections

Collaboration between these specialists ensures comprehensive care and the best possible outcomes for patients dealing with complex sinus-related issues.

Living with Chronic Sinusitis: Long-term Management and Quality of Life

For some individuals, sinus infections can become a chronic condition, leading to ongoing symptoms and an increased risk of complications. Chronic sinusitis is defined as inflammation of the sinuses that persists for 12 weeks or longer, despite treatment attempts.

Living with chronic sinusitis can significantly impact quality of life, affecting everything from sleep quality to work productivity. How can individuals manage this condition effectively?

Strategies for Managing Chronic Sinusitis

1. Adhere to a consistent nasal hygiene routine
2. Use long-term nasal corticosteroids as prescribed
3. Identify and avoid triggers (allergens, irritants)
4. Consider immunotherapy for allergy-related sinusitis
5. Explore surgical options for structural issues
6. Manage related conditions (e.g., asthma, allergies)

Can chronic sinusitis be cured? While complete cure may not always be possible, many individuals can achieve significant symptom relief and improved quality of life with appropriate management. Regular follow-ups with an ENT specialist are crucial for monitoring the condition and adjusting treatment as needed.

It’s important to note that chronic sinusitis increases the risk of developing the complications discussed earlier. Therefore, vigilant management and prompt attention to any changes in symptoms are essential for preventing more serious health issues.

Psychological Impact of Chronic Sinusitis

The persistent nature of chronic sinusitis can take a toll on mental health. Many individuals with this condition report higher levels of anxiety and depression. Addressing these psychological aspects is an important part of comprehensive care:

• Consider counseling or therapy to cope with chronic illness
• Join support groups to connect with others facing similar challenges
• Practice stress-reduction techniques like meditation or yoga
• Maintain open communication with healthcare providers about mental health concerns

By addressing both the physical and psychological aspects of chronic sinusitis, individuals can work towards maintaining a better quality of life despite the challenges posed by this condition.

What Happens if you Let a Sinus Infection go Untreated?

In most cases, sinus infection goes away on its own. However, if it lingers or keeps rearing its ugly head and you still keep overlooking it, a sinus infection can lead to potentially grave complications.

The possibility for serious health risks stems from the fact that your sinuses are too close to other parts of your body, especially your brain and eyes.

Here’s a list of some important complications that can arise as a result of an untreated sinus infection.

1. Reduced or Complete Loss of the Sense of Smell

Untreated sinus infection can diminish or completely deprive you of your sense of smell (called anosmia). This can be due to inflammation and blockage of your nasal passages, or damage to the olfactory nerve.

Though the loss of smell from a sinus infection is often transient, it can be permanent in severe cases, wreaking havoc on the quality of your life and overall wellbeing. 

2.

Difficulty Breathing

Sinusitis causes nasal and sinus congestion, which can make it difficult for you to breathe through your nose. If the inflammation gets better and the blocked sinuses start to drain, the breathing will become easier.

Difficulty breathing from a long-standing sinus infection can also make you feel fatigued, as it interferes with the delivery of enough oxygen to your body.

3. Inflammation of your Voice Box, aka Larynx (Laryngitis)

Untreated sinusitis can cause the thickened mucus to continuously drip down the back of your throat, which, over time, can irritate your voice box and contribute to dry cough and hoarseness.

4. Dacryocystitis

It is an inflammation or infection of the tear sac usually due to blockage of your tear duct. Long-standing sinus infection can spread to your eyes, including your tear sac — a tiny chamber draining your tears, located in the inner corner of your eye. Tears drain through this sac as they exit the surface of your eyes.

Dacryocystitis causes tearing, along with pain, redness, and swelling in the inner corner of the affected eye and warrants antibiotic treatment.

5. Orbital cellulitis/abscess

Another rare but serious complication of an untreated sinus infection is an inflammation or infection of the eye socket (aka orbit) — a condition called orbital cellulitis. This sight-and-life-threatening condition may arise because of the direct spread of infection from your sinuses via their thin walls, or as a repercussion of dacryocystitis.

Infection of the ethmoid sinuses — that lie between your nose and eyes — is more likely to spread to your eye socket because of their thin walls.

While this condition typically affects kids and young adults, a delay in diagnosis and treatment is a threat to both vision and life in all age groups. Untreated orbital infection can spread to the protective coverings around your brain and spinal cord as well as past your brain.

Orbital cellulitis causes fever, along with extreme pain, swelling, redness, and bulging of your eyelid, and possibly eyebrow and cheek. It may also lead to the formation of pus inside the eye socket.

Orbital cellulitis requires prompt hospitalization and may even necessitate surgery if the response to appropriate antibiotics has been poor within 24-48 hours.

6. Cavernous sinus thrombosis

When the sinus infection spreads to your brain, your body’s defense mechanisms create a clot in an attempt to contain the infection.

Though a very rare complication of chronic sinusitis, cavernous sinus thrombosis is a threat to life when it does emerge. It is a condition in which a blood clot forms inside the cavernous sinus — a hollow space at the base of the brain that functions to drain blood from your brain and face.

Cavernous sinus thrombosis presents with:

•   a sharp, severe headache that worsens progressively, and often occurs with tearing
•   facial pain, more localized around your eyes
•   high-grade fever
•   double vision
•   paralysis of eye muscles, resulting in an inability to move your eyes or causing your eyelids to droop
•   a bulging and swollen eyelid
•   loss of vision
•   seizures and death (in severe cases)

The cornerstone of treatment for cavernous sinus thrombosis is early and aggressive antibiotic therapy.

7. Meningitis

Left untreated, a sinus infection has the potential to spread to your meninges (the protective coverings around your brain and spinal cord), causing them to become inflamed — a condition called meningitis.

Meningitis gives rise to the following signs and symptoms:

•   Sudden, high-grade fever
•   Neck stiffness
•   Extremely severe headache, often accompanied by nausea and vomiting
•   Unusual sensitivity to bright light
•   Drowsiness and lethargy
•   Seizures

The condition requires intervention by a neurologist and is diagnosed by its clinical signs and symptoms. Meningitis is confirmed by withdrawing the clear fluid that bathes your brain and spinal cord — a procedure called lumbar puncture, in addition to imaging modalities, such as CT and MRI scans.

While the early institution of antibiotic therapy can help address the problem, sinusitis complicated by meningitis may still pose a serious threat.

8. Subdural Abscess

A chronic sinus infection can often lead to the collection of pus (aka abscess) in a potential space between the outer and middle layers of your meninges (the subdural space), defining a condition known as the subdural abscess.

Subdural abscess gives rise to signs and symptoms that resemble meningitis, along with changes in mental status, such as confusion and irritability. The condition progresses rapidly and calls for prompt diagnosis, treatment, and often surgical drainage to stave off coma and death from the rapidly rising pressure within your brain.

9. Frontal bone osteomyelitis

The frontal bone is a bone of your skull that occupies the forehead region. Osteomyelitis is an infection of a bone. Frontal bone osteomyelitis (aka Pott’s puffy tumor) is a potential local complication of a sinus infection of the paired frontal sinuses, located in the frontal bones above your eyebrows.

When infection from your frontal sinuses extend to the bones in which they lie, signs and symptoms that mimic meningitis arise. However, it’s imperative to distinguish between the two conditions, as lumbar puncture cannot be done with frontal bone infection due to the growing pressure within your brain.

Thanks to the antibiotic era, owing to which we rarely see cases of frontal bone osteomyelitis today. The key is timely diagnosis and treatment.

10. Brain abscess

A brain abscess is a localized collection of pus within your brain substance. It occurs because of the direct spread of infection from your paranasal sinuses.

As is obvious, brain abscess is a potentially lethal condition that can lead to coma and death if not addressed right away.

Seek Consultation

Untreated sinus infection can take a heavy toll on your wellbeing. The good news is that with advancements in medical and surgical treatments today, almost all complications of sinusitis are preventable.

Hence, our experts at the Ear, Nose, Throat & Allergy Specialist, recommend seeking treatment if you have symptoms of sinusitis lasting longer than ten days, or symptoms that keep coming back. These symptoms include fever, runny or blocked nose, congestion, facial pain, and tenderness.

A plethora of medical and lifestyle options are available to help address a sinus infection. Moreover, if conventional measures don’t help, our experts at the ENT & Allergy Specialist are also adept at performing a cutting-edge procedure to widen blocked sinuses, known as balloon sinuplasty.  

Balloon Sinuplasty

The steps of this procedure are as follows:

•   You’ll be given medicine to relax.
•   We first insert a thin, flexible tube known as an endoscope into your nose. This tube has a camera and light on its end, which is used to visualize the sinus cavity.
•   Another small tube termed as a catheter with a balloon at its end is next advanced over the guiding endoscope.
•   Our specialists then open up the inflamed sinuses by inflating the balloon.
•   The balloon is finally deflated and taken out.  

The success rates of a balloon sinuplasty are well over 90%. Most patients report a long-term, significant improvement in their sinus symptoms.

Balloon sinuplasty is minimally invasive (doesn’t involve any cutting) and doesn’t require placing a packing inside after the surgery. Thus, the recovery from the procedure is also relatively easy and quick.

Balloon sinuplasty has minimal to no risks, and in the majority of cases, this procedure helps you get off all your anti-allergy and steroid medicines as well as antibiotics that you might be taking for very long.

If you’re experiencing a sinusitis flare-up or are having symptoms of a chronic sinus infection, get one-on-one consultation by booking an appointment with one of our experts at the Ear, Nose, Throat & Allergy Specialist.

What Happens If A Sinus Infection Is Left Untreated?

By
David Volpi

/ March 3, 2017

A sinus infection can cause a long list of annoying problems, but if left untreated, your symptoms could continue for months on end. And in rare cases, very serious complications can develop.

In this blog, the board-certified physicians at New York ENT explain more about sinus infections and what can happen if they’re left untreated.

What is a sinus infection?

A sinus infection, which is sometimes referred to as sinusitis, occurs when the tissues that line your sinuses become inflamed or swollen. They’re usually filled with air, but when they become blocked and filled with fluid, an infection can result.

This type of infection can be caused by bacteria or viruses, and in rare cases, by fungi. Although colds, allergies, and anatomical issues such as a deviated septum don’t directly cause these infections, they can create blockages that create the right conditions for germs to grow and cause an infection.

What are the different types of sinus infections?

Most sinus infections are caused by viruses, and they’ll usually go away on their own. In fact, if the infection doesn’t clear up after a week to 10 days, it can be an indication that it’s caused by bacteria. It may have started as a bacterial infection, or a viral infection may develop into a bacterial infection after your sinuses become filled with fluid and bacteria then forms.

If you have sinus infections that seem to clear up only to shortly return, you probably have a bacterial infection. Thick, dark, or greenish-yellow nasal discharge is another indication, but your doctor can perform tests to verify the type of infection if needed.

Sinus infections can also be classified as acute or chronic. Acute infections usually start suddenly with symptoms such as a runny, stuffy nose and facial pain and can last up to four weeks. Chronic sinusitis occurs when your infection persists for at least 12 weeks despite attempts to treat it.

In the short term, a sinus infection can cause a long list of symptoms, including the following:

• Congestion
• Post-nasal drip
• Facial pain
• Headache
• Bad breath
• Coughing
• Fatigue
• Reduced sense of smell or taste

What happens if a sinus infection is left untreated?

A sinus infection that goes on for weeks without treatment can make you miserable and may develop into chronic sinusitis. If your infection is allowed to linger, it could also result in some potentially serious complications. These types of issues are rare, but they do occur.

• A sinus infection can spread to the eyes, causing redness, swelling, and reduced vision. In very severe cases, it can even cause blindness.
• When an infection spreads to the eyes, it’s usually treated with IV antibiotics. In addition, a CT scan may be needed to see if fluid needs to be drained.
• Sinus infections can also spread to the brain, but this is even rarer. It can lead to a brain abscess or meningitis, both of which can be life-threatening.
• An infection that lingers, gets worse or gets better only to quickly return needs to be treated by a doctor. An antibiotic may be all that’s needed, but in some cases, other treatment may be required.

If you’re experiencing symptoms that could indicate the presence of a sinus infection, make an appointment today with New York ENT. Our ear, nose, and throat doctors and surgeons will make sure you get the treatment you need to find relief and avoid potentially serious complications.

Sinusitis: causes, symptoms and treatment

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Sinusitis: types and methods of treatment

Causes of sinusitis

Often we do not even think about how competently and complexly the human body is arranged. The air passing through the nasal cavities (sinuses) is warmed and cleaned. When these sinuses become inflamed, we talk about such a thing as sinusitis (from the Latin sinus – sinus).

As a rule, sinusitis occurs due to an untreated runny nose, or as a complication after SARS. In addition, the causes of sinusitis can be a deviated septum, diseased adenoids, allergic rhinitis, and even a disease of the roots of the four back upper teeth.

How does the disease progress? Microbes, getting into the sinus, begin to multiply actively in it. Due to a decrease in immunity (due to illness, cold or allergies), the body cannot resist infection. Mucus begins to accumulate in the sinus, pus appears, which is absorbed into the bloodstream, slowly infecting the entire body. So there are diseases of the respiratory tract, including sinusitis.

In total, a person has 4 pairs of paranasal sinuses. Depending on the focus of inflammation, there are:

• sinusitis – inflammation of the mucous membrane of the maxillary sinus;
• frontal sinusitis – inflammation of the frontal sinus;
• ethmoiditis – inflammation of the ethmoid sinus;
• sphenoiditis – inflammation of the sphenoid sinuses.

Sometimes, with insufficient treatment, or with a very weakened immune system, polysinusitis occurs – inflammation of all sinuses.

Symptoms of sinusitis

A runny nose lasting more than 7-10 days is already a cause for concern. If the runny nose does not go away and the condition does not improve, then you should pay attention to the following signs of sinusitis:

• prolonged coryza with purulent discharge;
• dry mouth;
• fever;
• pain in the area of ​​inflamed sinuses, as well as in the area of ​​teeth, cheeks, eyes;
• increased sensitivity of certain parts of the face;
• general malaise.

If at least some of the above symptoms appear, then you should immediately contact an otolaryngologist.

Types of sinusitis

If sinusitis is not treated in a timely manner, the consequences can be very severe. It can cause eye disease, meningitis, inflammation of the blood vessels in the brain. In advanced form, this disease can cause the formation of polyps.

There are the following types of sinusitis:

• acute – develop as a result of SARS, which are caused by various pathogenic microbes. Symptoms are nasal congestion, fever, purulent discharge from the nose, sore throat when swallowing, swelling of the face is possible.
• chronic sinusitis – the causative agent in this case can be both a bacterial and a fungal infection. It develops as a result of incorrect or untimely treatment of tonsillitis or inflammatory processes of the dentition.
• exudative (purulent) – the focus of inflammation may be carious teeth, deviated septum or chronic rhinitis.
• productive – proliferation of tissue inside the sinuses (cysts, polyps).

Sinusitis treatment

For the treatment of sinusitis, it is first necessary to remove the swelling of the nasal mucosa. For this, vasoconstrictors are used. In parallel with this, there is treatment with anti-inflammatory, antibacterial, or antihistamine drugs. In some cases, if the disease is running, antibiotics are used.

We recommend reading articles on the following topics: The first signs of sinusitis and sinusitis

06/01/2022

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Hypothyroid coma. What is Hypothyroid Coma?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Hypothyroid coma is an urgent, extremely severe complication of decompensated hypothyroidism. At the initial stages, it is manifested by increased fatigue, lethargy, apathy. Gradually, there is a coldness of the extremities, blanching of the skin, swelling of the lower extremities. In a serious condition, slowing of breathing occurs, loss of consciousness, urination is disturbed, and blood pressure decreases. Diagnostic methods: collection of clinical and anamnestic data, laboratory tests and study of the work of blood vessels and the heart. Treatment includes therapy with thyroid drugs, restoration of vital functions of the body.

ICD-10

E03.5 Myxedematous coma

• Causes
• Pathogenesis
• Classification
• Symptoms of hypothyroid coma
• Complications
• Diagnostics
• Treatment of hypothyroid coma
• Prognosis and prevention
• Prices for treatment

General

Myxedematous, or hypothyroid, coma (HTC) was first described in 1879, and an active search for treatment began in 1964 years. Despite the intensive development of endocrinology in recent decades, the success of the treatment of this condition is still determined by the timeliness of diagnosis. HTC develops as a complication of any form of hypothyroidism, but occurs predominantly in patients with a primary disease. Epidemiological data are scarce. According to studies conducted in Europe and the USA, hypothyroid coma is detected in 0.1% of patients, among whom elderly women predominate (mean age 73 years). In about half of them, the main diagnosis is established retrospectively – after stabilization of the condition.

hypothyroid coma

Causes

A key factor in the development of coma is inadequate, untimely treatment of hypothyroidism – a sharp reduction in the daily dose or complete cessation of the use of thyroid drugs. The high-risk group is women over 50 years of age, and the older the patient, the higher the likelihood of decompensation of the disease. Causes of severe thyroid insufficiency include:

• Acute diseases. The occurrence of myxedema coma contributes to stroke, myocardial infarction, infectious diseases, heart failure, pneumonia. In addition, the state of coma can be triggered by hypothermia, internal bleeding, blood loss due to trauma, surgery.
• Metabolic disorders. The body’s need for thyroid hormones increases with hypoglycemia, hyponatremia, acidosis, hyperkalemia, hypoxia, hypercapnia. In the elderly, metabolic disorders can occur with severe stress, alcohol consumption.
• Taking medication. The most dangerous is the use of drugs that depress the functions of the central nervous system. HTC is triggered by long-term treatment with phenothiazines, tranquilizers, barbiturates, antihistamines, lithium preparations, diuretics, and beta-blockers.

Pathogenesis

The key pathogenetic mechanism in the development of GTK is an acute deficiency of thyroid hormones, which provokes a decrease in metabolic processes in the brain and hypoxia. Cerebral circulation slows down, consumption of oxygen and glucose by brain tissues decreases, carbohydrate, lipid, protein and water-salt metabolism is disturbed. There is tissue edema due to lymphostasis, fluid accumulates in the serous cavities. The pathology of the cardiovascular system is formed – the boundaries of the heart increase, the volume of blood decreases, the speed of blood flow decreases, and bradycardia increases.

As a result of inhibition of the functions of the hypothalamic centers, inhibition of energy metabolism and changes in the peripheral circulation, hypothermia develops. Failures in the autonomic nervous system cause shifts in the work of internal organs. Increasing respiratory failure, hypercapnia, cerebral edema, which is manifested by drowsiness, stupor and coma. Hypoventilation and low resistance to infection lead to pneumonia. An additional toxic effect on the central nervous system has a high concentration of carbon dioxide in the blood.

Classification

There are two options for the onset and development of coma in hypothyroidism. The first – the complication begins suddenly, accompanied by a sharp decrease in arterial and venous pressure, acute cardiovascular insufficiency. Another, more common form of the course is gradual: a coma unfolds gradually over several days or even months, symptoms appear progressively, from mild weakness to unconsciousness. There are four stages of HTC:

Predkom. The condition lasts for several hours or days. Periodically, an unconscious state occurs, the patient wakes up less and less, often falls into a deep sleep. There is a narrowing of the pupils, spontaneous rare movements, involuntary emptying of the intestines and bladder.

Symptoms of hypothyroid coma

In the pre-GTC stage, patients rarely pay attention to deterioration. The main manifestations of hypothyroidism are aggravated: the skin becomes drier, hair falls out more actively, hoarseness of the voice increases, swelling around the eyes and swelling of the extremities increase, the temperature decreases slightly. With the development of hypothyroid coma, a violation of tolerance to cold is determined, stable hypothermia from 35-36 ° C in the early stages to 26 ° C and below in a state of deep coma. If the patient has a concomitant infection or other acute illness, the temperature can remain at the level of subfebrile values ​​for a long time. In most diagnostic cases, hypothermia is the first and key symptom of HTC, and the dynamics of body temperature is considered as a criterion for the effectiveness of treatment and is used to predict survival.

Other symptoms of myxedematous coma are an increase in drowsiness, apathy, the patient’s unwillingness to engage in conversation, emotional impoverishment, and inhibition of reflexes. Decrease in pulse rate, vascular hypotension, slowing of the breathing process, most pronounced in women with obesity, underdeveloped respiratory muscles, is determined. In the first stages of coma, acute urinary retention, chronic or acute intestinal obstruction, bleeding in various parts of the gastrointestinal tract are possible. Later they are sometimes replaced by involuntary defecation and urination. Without adequate therapy, the phenomena of hypoglycemia, hypothermia, hypercapnia, hypoxia, vascular and muscle hypotension increase, breathing and heart rate slow down. Oxygen starvation leads to a change in the work of the vital parts of the central nervous system. The cause of death is respiratory and cardiovascular failure.

Complications

Long-term undiagnosed hypothyroid coma can be complicated by mental disorders. Patients develop delusional thinking disorders, hallucinations, personality changes, acute psychoses, neuroses. The state of decompensation of severe hypothyroidism is accompanied by a decrease in the cognitive sphere – attention, memory, intellectual abilities, orientation in space and time worsen. In rare cases, acute psychotic states unfold. They do not have specific features, they mimic paranoid or affective psychosis. This complicates the diagnosis and contributes to the erroneous diagnosis of a mental disorder.

Diagnosis

With a typical clinical picture, the diagnosis of hypothyroid coma is not difficult. However, at a late stage, the general condition of patients is regarded as severe, and a full examination is extremely difficult to perform. The main data collection activities are carried out by an endocrinologist. During the initial survey of the patient or his relatives, an assumption is made about HTC, which must be differentiated from cerebrovascular accident, mechanical intestinal obstruction, adrenal insufficiency, and intoxication. A comprehensive examination includes:

• History taking. Some patients have a confirmed diagnosis of hypothyroidism 5 or more years ago. Often in the history of the disease or in the responses of the patient there are indications of a family history of endocrine diseases, radioiodine therapy, thyroidectomy, unreasonably interrupted treatment with thyroid hormones.
• Inspection. On physical examination, periorbital edema, dense swelling of the feet, dryness and pallor (sometimes cyanosis) of the skin, hypothermia, slowness and lethargy of movements, and a decrease in tendon reflexes are determined. On the neck, a scar after thyroidectomy, non-palpable thyroid gland can be determined.
• Laboratory diagnostics. A general and biochemical analysis of blood and urine, a study of the level of electrolytes, hormones, specific markers of damage to the thyroid gland, myocardium, and muscles are carried out. Laboratory diagnostic signs of GTK include: elevated TSH, low levels of free thyroxine and triiodothyronine, hypoxia, hypercapnia, anemia, leukopenia, hyponatremia, hypochloremia, hypoglycemia, elevated levels of creatinine, creatine kinase, transaminases and lipids.
• Study of cardiovascular function. According to the results of the ECG, sinus bradycardia, low voltage of the teeth, depression of the ST segment are detected. Measurement of blood pressure gives consistently low and low readings – from 90/60 mm. rt. Art. The pulse rate is less than 60 beats per minute.

Treatment of hypothyroid coma

Vigorous complex therapy is necessary for all patients, as there is a potentially high probability of death. The efforts of doctors are aimed at compensating for respiratory, cardiac and vascular insufficiency, correcting metabolic disorders, and restoring hormone levels. The patient care plan looks like this:

• Therapy with hormonal drugs. A combination of thyroid drugs and glucocorticoids is prescribed. The latter are canceled after the patient regains consciousness.
• Elimination of hypoglycemia. An increase in plasma sugar levels is necessary for the normal functioning of the heart muscle and brain structures. A glucose solution is administered intravenously with parallel control of blood pressure and urination.
• Elimination of respiratory failure. The patient’s breathing is slow and weak. Oxygen inhalation therapy is carried out, artificial lung ventilation devices are connected. If the condition worsens, drugs are administered that stimulate the respiratory center and airways.
• Elimination of heart failure. Hypertensive drugs compatible with thyroid drugs are indicated. Cardiac glucosides are administered to correct heart failure.
• Elimination of hypothermia. Patients are kept warm with blankets (no heating pads). When the effect of thyroid drugs is manifested, the temperature rises to normal.
• Normalization of blood composition. Most patients need to prevent the development of anemia. Blood transfusion or erythrocyte mass is performed.

Prognosis and prevention

Hypothyroid coma in the later stages is difficult to treat. The prognosis is relatively favorable in middle-aged people, with early medical attention, with proper emergency care and therapy. To prevent the development of GTK, you should strictly follow the rules for the treatment of hypothyroidism, immediately seek help from an endocrinologist if you feel worse, and eliminate concomitant serious diseases. It is unacceptable to independently cancel or change the regimen for taking thyroid hormonal drugs developed by a doctor.

You can share your medical history, what helped you in the treatment of hypothyroid coma.

Sources

1. Hypothyroid coma – modern approaches to diagnosis and treatment / Petunina N.