Myxedema Coma Diagnostic Score calculator

Clinical inputs

• Temperature (°C)Accepted range: 25 to 42
• Central nervous system
• Gastrointestinal findings
• Precipitating event
• Heart rate (/min)Accepted range: 20 to 180
• Other electrocardiogram changes
• Pericardial or pleural effusion
• Pulmonary edema
• Cardiomegaly
• Hypotension
• Hyponatremia
• Hypoglycemia
• Hypoxemia
• Hypercarbia
• Decrease in glomerular filtration rate

Primary source

Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, Mete M, Desale S, Wartofsky L. A diagnostic scoring system for myxedema coma. Endocr Pract. DOI: 10.4158/EP13460.OR. PMID: 24518183. The 2014 table was not in the open article text. The point rows were read from Table 2 of Wartofsky L, Klubo-Gwiezdzinska J. Thyroid emergencies. In: Feingold KR et al. Endotext. PMID: 31237256, which reprints the Popoveniuc system. Temperature above 35 °C is 0, 32 to 35 °C is 10, and below 32 °C is 20. Central nervous system: absent 0, somnolent or lethargic 10, obtunded 15, stupor 20, coma or seizures 30. Gastrointestinal: absent 0, anorexia or abdominal pain or constipation 5, decreased intestinal motility 15, paralytic ileus 20. A precipitating event is 10. Heart rate of 60/min or higher is the absent bradycardia row (0), 50 to 59 is 10, 40 to 49 is 20, and below 40 is 30. Other electrocardiogram changes, pericardial or pleural effusion, pulmonary edema, cardiomegaly, and hypotension add 10, 10, 15, 15, and 20. Hyponatremia, hypoglycemia, hypoxemia, hypercarbia, and a decrease in glomerular filtration rate each add 10. The Table 2 footnote says 60 or higher is highly suggestive or diagnostic, 25 to 59 suggests risk, and below 25 is unlikely. The 2014 abstract instead places increased risk at 45 to 59. These bands follow the footnote printed with the opened table. (2014)