Although rare, the differential diagnosis of hypoventilation and hypercapnia respiratory failure includes hypothyroidism. It is usually associated with severe hypothyroidism (i.e. myxedema coma) .
The suspected mechanism(s) by which hypothyroidism causes hypoventilation are:
- Depression of the central ventilatory drive response to hypercapnia/hypoxia .
- Skeletal muscle myopathy with a weakening of the diaphragm and intercostal muscles [3-4].
Typically, the introduction of levothyroxine [T4] supplementation will reverse the underlying pathology [5-6].
- NORDQVIST P, DHUNER KG, STENBERG K, ORNDAHL G. Myxoedema coma and carbon dioxide-retention. Acta Med Scand. 1960 Mar 10;166:189-94.
- Duranti R, Gheri RG, Gorini M, et al. Control of breathing in patients with severe hypothyroidism. Am. J. Med. 1993;95:29–37.
- Siafakas NM, Salesiotou V, Filaditaki V, Tzanakis N, Thalassinos N, Bouros D. Respiratory muscle strength in hypothyroidism. Chest. 1992 Jul;102(1):189-94.
- Schlenker EH. Effects of hypothyroidism on the respiratory system and control of breathing: Human studies and animal models. Respir Physiol Neurobiol. 2012 Apr 30;181(2):123-31.
- Ladenson PW, Goldenheim PD, Ridgway EC. Prediction and reversal of blunted ventilatory responsiveness in patients with hypothyroidism. Am J Med. 1988 May;84(5):877-83.
- Behnia M, Clay AS, Farber MO. Management of myxedematous respiratory failure: review of ventilation and weaning principles. Am. J. Med. Sci. 2000;320:368–373.
Dr. C Humphreys
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