SudaMediCa, The Sudanese Medical Community

Myxoedema coma is a rare but very important to diagnose medical emergency.

The clues toward this diagnosis are

'Yellowish hue' (referring to carotinaemia)
Obesity
Bradycardia
Hypothermia
Coma.

This could easily be in case of chronic hypothyroidism that can be precipitated by an acute infection

what is the management?

1. Supportive care: treat hypotension with crystalloid, treat hypothermia, support the airway and intubate if needed

2. start IV thyroid hormone as soon as possible up on suspecting the diagnosis (of course after sending the blood tot he lab and after stabilizing life threatening issues)

3. involve the ICU and Endocrine team

4. Pray for your patient while you do all the above because the outcome are usually poor due to delayed diagnosis and treatment and development of complications of hypotension and hypo-perfusion

Mortality rate in myxedema coma has historically been as high as 80%. Some data suggest that aggressive management and early recognition have improved the mortality rate to 15-20%. However, a more recent observational study was unable to show significant differences in outcome based on replacement therapeutic methods, with a mortality rate remaining high at 40%

I remembered one case during my internship she was a female 40 years old who underwent an appendectomy but after that she didnt recover from anesthesia for no obvious reason ,patient admitted to ICU ,brilliantly one of the registrars and on his evening follow up rounds noticed that she has a slightly high lipid profile and he suspected hypothyroidism ,did thyroid panel and BAAAAM its hypothyroidism ,thyroxine started immediately and patient recovered from anesthesia after 24 hour discharged from ICU after 48 hours