Myxoedema Coma: A Very Rare Presentation of Severe Hypothyroidism

Myxoedema coma is a rare and life threatening medical emergency with a high mortality rate. It results from severe hypothyroidism and affects almost every organ system. The salient features of myxoedema coma are decreased mental status and hypothermia, but other characteristics of severe hypothyroidism are usually present including bradycardia, hypotension, hypoglycemia and hypoventilation. Abnormal accumulation of mucin in skin and other tissues can lead to typical clinical features, for example nonpitting oedema, swollen lips, enlarged tongue and thickened nose. Diagnosis is challenging due to the paucity of cases and possibly earlier recognition of hypothyroidism as a result of improved availability of thyrotropin (TSH) assays. Clinicians can be mislead by the misnomer “coma” as patients may present with signs of cognitive impairment such as agitation, confusion and disorientation. A high index of suspicions is needed among clinicians in order to rapidly recognize the condition and make an early diagnosis. Treatment should be commenced on clinical grounds while waiting for laboratory results. It is also vital that these patients receive intensive care level treatment with close monitoring of their cardiovascular parameters and level of consciousness. In addition, severe hypothyroidism can decompensate to myxoedema coma as a result of precipitating factors, for example cold exposure, alcohol, sedative drugs, sepsis or myocardial infarction. Therefore, it is important to address and try to reverse any of these precipitants. J Med Cases. 2013;4(11):715-718 doi: https://doi.org/10.4021/jmc1503w