Respiratory failure in myxedema is a complex medical emergency and may requ
ire prolonged ventilatory assistance. Appropriate management of this medica
l problem requires an understanding of its effects on the central nervous s
ystem and peripheral neuromus-culoskeletal system. Weaning of these patient
s can be very protracted and requires a diligent multidisciplinary apt;roac
h. Because of its infrequency, ventilatory management of severe hypothyroid
ism has not been studied in a controlled fashion. The first part of this re
view discusses the mechanisms of respiratory failure in myxedema. The secon
d part explores strategies in mechanical ventilation and weaning of myxedem
atous patients.