<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0001-6002</journal-id>
<journal-title><![CDATA[Acta Médica Costarricense]]></journal-title>
<abbrev-journal-title><![CDATA[Acta méd. costarric]]></abbrev-journal-title>
<issn>0001-6002</issn>
<publisher>
<publisher-name><![CDATA[Colegio de Médicos y Cirujanos de Costa Rica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0001-60022019000400187</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Coma mixedematoso como presentación de hipotiroidismo]]></article-title>
<article-title xml:lang="en"><![CDATA[Myxedema coma as presentation of hypothyroidism]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Albín-Cano]]></surname>
<given-names><![CDATA[Roberto Gabriel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Parada-Valdés]]></surname>
<given-names><![CDATA[Alexis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramírez-Quintana]]></surname>
<given-names><![CDATA[José O.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Ciencias Médicas de La Habana. Departamento de Medicina Interna. Hospital Clínico- Qui]]></institution>
<addr-line><![CDATA[La Habana ]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2019</year>
</pub-date>
<volume>61</volume>
<numero>4</numero>
<fpage>187</fpage>
<lpage>189</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S0001-60022019000400187&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S0001-60022019000400187&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S0001-60022019000400187&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen Se presenta un caso de una paciente de 69 años de edad y sin antecedentes personales o familiares de patología tiroidea alguna, que asiste con un estado convulsivo de aparición súbita, de hemicuerpo derecho y relajación esfinteriana, asociado, además, a trastornos del estado de conciencia, bradicardia, bradipnea y edema de difícil Godet en miembros inferiores. Los exámenes complementarios mostraron acidosis respiratoria, hiposecreción de T4 y elevación de la hormona estimulante de la tiroides por retroalimentación negativa. Estos resultados corroboraron el diagnóstico presuntivo de coma mixedematoso. Se emprendió el tratamiento hormonal correspondiente con levotiroxina, al cual respondió satisfactoriamente y fue egresada a los 24 días de su ingreso, pendiente de valoración por el especialista de endocrinología.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract We present the case of a 69-year-old female patient with no personal or family history of any thyroid disease, who attends with a convulsive state of sudden onset, right hemibody and sphincter relaxation, also associated with disorders of the state of consciousness, bradycardia, bradypnea and edema of difficult godet in lower limbs. Complementary analyses showed respiratory acidosis, hyposecretion of T4 and elevation of the thyroid stimulating hormone by negative feedback. These results corroborated the presumptive diagnosis of myxedema coma. The corresponding hormonal treatment with levothyroxine was undertaken, to which it responded satisfactorily and was discharged 24 days after admission, pending evaluation by the endocrinology specialist for an outpatient hormone replacement therapy.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[coma mixedematoso]]></kwd>
<kwd lng="es"><![CDATA[hipotiroidismo]]></kwd>
<kwd lng="es"><![CDATA[hormonas tiroideas]]></kwd>
<kwd lng="es"><![CDATA[emergencia endocrina]]></kwd>
<kwd lng="en"><![CDATA[Myxedema Coma]]></kwd>
<kwd lng="en"><![CDATA[Hypothyroidism]]></kwd>
<kwd lng="en"><![CDATA[thyroid hormones]]></kwd>
<kwd lng="en"><![CDATA[endocrine emergency]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ángeles]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Estructura y función de la glándula tiroides.]]></article-title>
<source><![CDATA[Rev. ORL,]]></source>
<year>2016</year>
<volume>7</volume>
<numero>^s2</numero>
<issue>^s2</issue>
<supplement>2</supplement>
<page-range>7-16.</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[López]]></surname>
<given-names><![CDATA[ITM]]></given-names>
</name>
<name>
<surname><![CDATA[Samón]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Anderson]]></surname>
<given-names><![CDATA[JR.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Coma mixedematoso en hombre de 74 años: reporte de caso con revisión narrativa.]]></article-title>
<source><![CDATA[Medwave]]></source>
<year>2013</year>
<volume>13</volume>
<numero>4</numero>
<issue>4</issue>
</nlm-citation>
</ref>
<ref id="B3">
<label>3.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Paul]]></surname>
<given-names><![CDATA[Palacios Moguel]]></given-names>
</name>
<name>
<surname><![CDATA[Miguel]]></surname>
<given-names><![CDATA[Cepeda Jiménez]]></given-names>
</name>
<name>
<surname><![CDATA[Manuel.]]></surname>
<given-names><![CDATA[Arellano Estrada Juan]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Coma mixedematoso y síndrome de Ogilvie asociado a aripiprazol, memantina y venlafaxina. Reporte de caso.]]></article-title>
<source><![CDATA[Med. crít. (Col. Mex. Med. Crít.)]]></source>
<year>2016</year>
<volume>30</volume>
<page-range>342- 6</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ticse]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Valenzuela]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Villena]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Huachin]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Pinto]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Guillen]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Coma mixedematoso e insuficiencia renal: Reporte de casos y revisión de la literatura.]]></article-title>
<source><![CDATA[Rev Med Hered]]></source>
<year>2011</year>
<volume>22</volume>
<page-range>82-5</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Meléndez]]></surname>
<given-names><![CDATA[GAG]]></given-names>
</name>
<name>
<surname><![CDATA[Betanzos]]></surname>
<given-names><![CDATA[RR]]></given-names>
</name>
<name>
<surname><![CDATA[Pedraza]]></surname>
<given-names><![CDATA[VS]]></given-names>
</name>
<name>
<surname><![CDATA[Palomo]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Hernández]]></surname>
<given-names><![CDATA[CFM]]></given-names>
</name>
<name>
<surname><![CDATA[Montaño]]></surname>
<given-names><![CDATA[SA.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hypothyroidism]]></article-title>
<source><![CDATA[Med Int Méx]]></source>
<year>2010</year>
<volume>26</volume>
<page-range>462-71</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sasazawa]]></surname>
<given-names><![CDATA[DT]]></given-names>
</name>
<name>
<surname><![CDATA[Tsukumo]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Lalli]]></surname>
<given-names><![CDATA[CA.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Myxedema coma in a patient with type 1 neurofibromatosis: rare association.]]></article-title>
<source><![CDATA[Arq Bras Endocrinol Metab]]></source>
<year>2013</year>
<volume>57</volume>
<page-range>743-7</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Leal Curí]]></surname>
<given-names><![CDATA[L.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Coma mixedematoso.]]></article-title>
<source><![CDATA[Rev Cub End.]]></source>
<year>2012</year>
<volume>23</volume>
<page-range>273-80</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rizzo]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
<name>
<surname><![CDATA[Mana]]></surname>
<given-names><![CDATA[DL]]></given-names>
</name>
<name>
<surname><![CDATA[Bruno]]></surname>
<given-names><![CDATA[OD]]></given-names>
</name>
<name>
<surname><![CDATA[Wartofsky]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Coma mixedematoso.]]></article-title>
<source><![CDATA[Medicina]]></source>
<year>2017</year>
<volume>77</volume>
<publisher-loc><![CDATA[Buenos Aires ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mathew]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Misgar]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<name>
<surname><![CDATA[Ghosh]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Mukhopadhyay]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Roychowdhury]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Pandit]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Myxedema coma: a new look into an old crisis.]]></article-title>
<source><![CDATA[Journal of thyroid research.]]></source>
<year>2011</year>
</nlm-citation>
</ref>
<ref id="B10">
<label>10.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rebollo-Gómez]]></surname>
<given-names><![CDATA[H.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Coma mixedematoso. Informe de un caso.]]></article-title>
<source><![CDATA[Rev Med Inst Mex Seguro Soc]]></source>
<year>2010</year>
<volume>48</volume>
<page-range>215-7</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nazar]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Bastidas]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Zamora]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Coloma]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Fuentes]]></surname>
<given-names><![CDATA[R.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Manejo perioperatorio de pacientes con patología tiroidea y tratamiento crónico con corticoides.]]></article-title>
<source><![CDATA[Rev Chil Cir.]]></source>
<year>2016</year>
<volume>68</volume>
<page-range>87-93</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Andrés]]></surname>
<given-names><![CDATA[Domínguez-Borgúa]]></given-names>
</name>
<name>
<surname><![CDATA[Fonseca-Entzana Marcos]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Trejo-Martínez Miguel]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Coma Mixedematoso]]></article-title>
<source><![CDATA[Med Int Méx]]></source>
<year>2015</year>
<volume>31</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B13">
<label>13.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Romero]]></surname>
<given-names><![CDATA[IIT]]></given-names>
</name>
<name>
<surname><![CDATA[Robledo]]></surname>
<given-names><![CDATA[GC]]></given-names>
</name>
<name>
<surname><![CDATA[Maldonado]]></surname>
<given-names><![CDATA[PÁ]]></given-names>
</name>
<name>
<surname><![CDATA[Núñez Pérez-Redondo]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Vargas]]></surname>
<given-names><![CDATA[CW]]></given-names>
</name>
<name>
<surname><![CDATA[Cicero Sabido]]></surname>
<given-names><![CDATA[R.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hipotiroidismo y extubación fallida. Comentario breve a propósito de un caso.]]></article-title>
<source><![CDATA[Rev Asoc Mex Med Crit y Ter Int]]></source>
<year>2013</year>
<volume>27</volume>
<page-range>115-8</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pedroza-Mosquera]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez-Ríos]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Solarte-Bastidas]]></surname>
<given-names><![CDATA[YA]]></given-names>
</name>
<name>
<surname><![CDATA[Vallejo]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Coma mixedematoso e insuficiencia cardíaca. Reporte de un caso clínico]]></article-title>
<source><![CDATA[Rev Mex Endocrinol Metab Nutr.]]></source>
<year>2017</year>
<volume>4</volume>
<page-range>188-91.</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[alinas Arce]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Pinto Valdivia]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Solórzano Altamirano]]></surname>
<given-names><![CDATA[P.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hipotiroidismo inducido por Amiodarona: Reporte de caso.]]></article-title>
<source><![CDATA[Rev Med Hered]]></source>
<year>2012</year>
<volume>23</volume>
<page-range>45-7</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Casuso]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Nan]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Hernández]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Regata]]></surname>
<given-names><![CDATA[OG]]></given-names>
</name>
<name>
<surname><![CDATA[Alonso]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[González-Macías]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Disfunción tiroidea inducida por amiodarona. Análisis en condiciones de práctica clínica habitual.]]></article-title>
<source><![CDATA[Med Int Méx.]]></source>
<year>2011</year>
<volume>27</volume>
<page-range>231-7</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
