Endocrine Abstracts

Myxoedema coma is a rare, fatal manifestation of severe hypothyroidism characterized by altered mental status and multisystem dysfunction. It often occurs in the setting of long-term untreated hypothyroidism, triggered by infection and hypothermia. This case explores a patient presenting with myxoedema coma as the initial presentation of autoimmune hypothyroidism which was initially misdiagnosed as depression. A previously healthy 46-year-old woman was admitted to the emergency department with a sacral fracture following a fall. Her examination showed cognitive slowing, non-pitting oedema and proximal myopathy. Despite a history of recurrent falls, she avoided seeking medical attention due to negative past experiences. Following the death of her mother for whom she had been a caregiver, she experienced severe self-neglect, social isolation and significant weight loss. She was diagnosed with depression in the community a few weeks prior to hospital admission and prescribed antidepressants. On admission to hospital, investigations confirmed profound hypothyroidism with positive thyroid antibodies. Her condition was complicated by severe electrolyte imbalances, acute kidney injury, ischemic liver injury secondary to persistent hypotension, pleural effusion, clotting abnormalities, malnourishment and inpatient falls. Her clinical presentation combined with biochemical abnormalities was indicative of myxoedema coma with multiorgan dysfunction. Treatment was initiated with high dose thyroxine and supportive measures. This case illustrates the importance of considering organic causes of psychiatric symptoms such as depression, particularly when accompanied by physical signs like proximal muscle weakness and recurrent falls. The patient’s delayed presentation, compounded by social isolation and caregiving responsibilities allowed her condition to progress without timely intervention. Initial misdiagnosis in the community led to delayed initiation of treatment and subsequently multiorgan dysfunction. Early recognition, prompt thyroid replacement combined with a multidisciplinary approach were key to her recovery. This case also highlights the importance of considering psychosocial factors in the management of chronic conditions.