Myxedema Coma: A Forgotten Medical Emergency With a Precipitous Onset

Abstract

Myxedema coma is a rare life-threatening disorder characterized by severe hypothyroidism leading to multiorgan failure and even death. This case also reminds clinicians that the misnomer "coma" is misleading, and the patient can present with less severe symptoms. We present a case of a 72-year-old female with a history of primary hypothyroidism who presented to the emergency department with progressively worsening confusion for three days. Laboratory results revealed thyroid-stimulating hormone (TSH) 402.0 µU/L and free thyroxine (T4) 0.22 ng/dL. The patient was compliant with the levothyroxine but she found to be malnourished on presentation. The patient was treated with intravenous levothyroxine and liothyronine. The patient's mental status improved to the baseline, and she was discharged to a skilled nursing facility. Myxedema coma is a rare but life-threatening disorder that providers should be familiar with, including management and treatment. To the best of our knowledge, this is the highest TSH level ever reported so far, and the first case of myxedema coma precipitated due to malnutrition.

Keywords: malnutrition; myxedema coma; severe hypothyroidism.