Myxoedema coma is an extreme form of hypothyroidism that has a high mortality. It is rare, but it can occur in patients with undiagnosed or undertreated hypothyroidism.
- Precipitating factors
- Hypothermia
- Myocardial infarction
- Stroke
- Congestive heart failure
- Infection
- Drugs
- Anaesthetics
- Sedatives
- Narcotics
- Amiodarone
- Lithium
- Trauma
- Signs and symptoms
- Symptoms of hypothyroidism
- Hypothermia
- Hypoglycemia
- Cyanosis
- Bradycardia
- Hypotension
- Coma
- Seizures
- Psychosis (myxoedema madness)
- Investigations
- Thyroid function test
- Markedly elevated TSH (95%), 5% may be caused by central TSH failure
- Low free T4
- Low T3
- Random blood glucose to check for hypoglycaemia
- Electrolytes
- Hyponatremia
- Complete blood count
- Anaemia
- Serum cortisol to rule out adrenal insufficiency
- Blood and urine cultures
- Thyroid function test
- Treatment
- Admit to the ICU
- If fluid resuscitation and vasoactive agents
- Active warming using blankets or fluids
- Hydrocortisone if adrenal or pituitary insufficiency is suspected
- Intravenous liothyronine (T3) or levothyroxine (T4)
- Correct hypoglycaemia
- Antibiotics if infection is suspected
- Treat any other precipitants