Jul 23, 1960
British Medical Journal
aforesaid " logical " regimen of treatment. The precipitate application of heat to subjects in a state of hypothermic coma caused by myxoedema must have the effect of accelerating the physiological activities of the tissues, thereby increasing the oxygen requirements of the latter. Moreover, the rapid introduction of large amounts of thyroid hormone into the system of these comatose subjects must likewise result in a marked acceleration of cellular metabolism and oxygen utilization. This point is underlined by the fact that the survival time of -animals placed in a closed vessel is -decreased after the administration of thyroxine or triiodothyronine.' It is likely that in many instances of myxoedematous coma the patient's cardiovascular system (impaired by the effects of long-standing hyperthyroidism) is unable to cope with a sudden augmentation of the amount of oxygen needed by the tissues, and that this state of affairs can lead to disaster. In regard to the problems involved in the treatment of patients in myxoedematous coma, it is noteworthy that Macdonald2 has concluded that " rewarming is illogical and probably dangerous," and Nieman' that intravenous tri1⁄4odothyronine has brought no improvement and may indeed be dangerous in producing a too rapid acceleration of metabolism."