Correct!
6. 2 and 4

Ventilatory drives, both hypoxic and hypercapnic, are significantly blunted in the hypothyroid state and further diminished in myxedema (6). These improve with replacement therapy. There also may be skeletal muscle weakness contributing to respiratory failure. Testing for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) show reduced strength which improves with treatment of the hypothyroidism. Impaired diffusion capacity, and obstructive sleep apnea are both reversible respiratory manifestations of hypothyroidism (7).

References

  1. Dutta P, Bhansali A, Masoodi SR, Bhadada S, Sharma N, Rajput R. Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Crit Care 2008;12:R1. [CrossRef] [PubMed]
  2. Beyon J, Akhtar S, Kearney T. Predictors of outcome in myxoedema coma. Crit Care. 2008;12(1):111. [CrossRef] [PubMed]
  3. Klubo-Gwiezdzinska J, Wartofsky L. Thyroid emergencies. Med Clin North Am. 2012;96(2):385-403. [CrossRef] [PubMed] 
  4. Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Pandit K, Mukhopadhyay S, Chowdhury S. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011;2011:493462.
  5. Persani L. Central Hypothyroidism: Pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab. 2012:97:3068–3078. [CrossRef] [Pubmed]
  6. Zwillich CW, Pierson DJ, Hofeldt FD, Lufkin EG, Weil JV. Ventilatory control in myxedema and hypothyroidism. N Engl J Med. 1975;292(13):662-5. [CrossRef] [PubMed]
  7. Schlenker EH. Effects of hypothyroidism on the respiratory system and control of breathing: Human studies and animal models. Respir Physiol Neurobiol. 2012;181(2):123-31. [CrossRef] [PubMed]

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