Endocrine Abstracts

Myxedema coma is a potentially lethal presentation of severe hypothyroidism. It is a rare condition in the Western society. We present a 72-year-old woman with a myxedema coma precipitated by a urinary tract infection. The patient was admitted to the emergency ward in a subcomatose state featuring hypothermia, hypotension, bradycardia and hypoxia. Diagnosis of myxedema by the attending Emergency Physician was suggested based on clinical presentation. The consulting endocrinologist questioned the diagnosis due to the lack of thyroid related disease at initial review of her medical history and because of its rare incidence. Thyroid tests confirmed the diagnosis of myxedema and subsequent treatment with levothyroxine and liothyronine intravenously resulted in a rapid amelioration of the patient’s physical and mental state. During the patient’s stay in the hospital it became clear that she had previously been on radioactive iodine therapy for Graves’ disease, but that follow-up had been neglected. The case presented here highlights the importance of knowledge of low incidence endocrine disease in the emergency department. Patient who undergo treatment with radio-active iodine should be actively encouraged and reminded to follow up the effects of the treatment. This statement is of particular importance in the current COVID- 19 lock down period. Patients are scared to pursue their regular follow-up. Tele-consultations and video consultations may be an alternative to face to face consultations in order to avoid loss to follow-up and detect timely overt thyroid dysfunction.