Endocrine Abstracts

Background: Myxedema coma is an uncommon but life-threatening condition of severe and decompensated hypothyroidism requiring early recognition and prompt treatment. The aim of this study is to describe the clinical features and identify factors associated with mortality of our patients diagnosed myxedema coma over the past 15 years.

Materials and methods: Retrospective chart review of patients diagnosed and treated at King Chulalongkorn Memorial Hospital for myxedema coma during 2002–2016 was performed. Their demographic data, clinical features, precipitating factors and treatment outcomes were analyzed. We also compared different scoring systems including Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score and Wartofsky myxedema coma score to predict the outcomes.

Results: A total of 13 cases, 9 females and median age of 79 years ranged between 60-94 years, were recruited. All of them had primary hypothyroidism. Seven patients (54%) were newly diagnosed hypothyroidism at the time of presentation of myxedema coma. Six patients (46%) died and sepsis was the major cause of death. Lower FT₄ level was only parameter significantly different between the patients who survived and those who died (P=0.04). On analyzing the various scoring systems, they did not demonstrate a significant difference between survivors and non-survivors; however, a Wartofsky myxedema score below 90 was associated with a better outcome.

Conclusions: Myxedema coma still carries a high mortality rate even with the appropriate diagnosis and treatment. With a high proportion of undiagnosed hypothyroid patients in our study, it should be alert clinicians to beware of this preventable condition in an appropriate clinical context. Thyroid hormone levels and Wartofsky myxedema score may be applied as clinical prognostic parameters.