Endocrine Abstracts (2015) 38 P489 | DOI: 10.1530/endoabs.38.P489

If it feels like myxoedema coma, then it probably is!

Heechan Kang, Waiel A Bashari & Samson O Oyibo

Endocrinology Department, Peterborough City Hospital, Peterborough, UK.

Introduction: Myxodedema coma comprises a complex endocrinological emergency whereby there is severe clinical hypothyroid state. It is a life threatening yet a potentially reversible condition that may prove rather difficult to recognise due to the complex symptomatology. Very few articles report the specific therapy for myxoedema coma.

The case: Here we present an elderly lady with previous total thyroidectomy, who despite receiving oral thyroxin tablets, her TSH maintains at a marginally increased level with normal fT3 and fT4. She presented to the hospital with a trivial urinary tract infection and dehydration for which she was treated with antibiotics and fluids, but despite all, she still exhibited profound hypothermia, bradycardia with obtunded consciousness levels and signs of a severe hypothyroid crisis. Only two intravenous pulses of Tri-iodothyronine (T3) saw the patient making a remarkable recovery within hours to being able to take Levothyroxine orally and maintain response.

Conclusion: This case describes success with intravenous T3 monotherapy and demonstrates how myxoedema coma can present even with normal serum thyroid hormones; both phenomena are sparsely reported in the literature. We hope to emphasise both the reversibility and the potential life-threatening consequences of myxoedema coma and highlight issues when it presents among multiple co-morbidities posing a wider differential diagnosis; ultimately to raise the clinicians’ suspicion to swiftly tailor the examination and treat promptly perhaps, regardless of the initial serum thyroid function tests.

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