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Case Reports
. 2024 Aug 3;16(8):e66053.
doi: 10.7759/cureus.66053. eCollection 2024 Aug.

Myxedema Coma: Recognition of a Rare Endocrine Emergency

José Guilherme Assis  1 , Anabela Santos  2
Affiliations
Case Reports

Myxedema Coma: Recognition of a Rare Endocrine Emergency

José Guilherme Assis et al. Cureus. .

Abstract

An 82-year-old patient with multiple comorbidities presented to the emergency department with progressive dyspnea, orthopnea, and anorexia. Despite initial treatment for community-acquired pneumonia and decompensated heart failure, her condition deteriorated, manifesting as severe hypotension, bradycardia, and refractory hypothermia. A detailed medical history and extensive systematic investigation led to the documentation of hypothyroidism complicated by myxedema coma, in the context of chronic amiodarone use and precipitated by sepsis. Treatment with intravenous levothyroxine and glucocorticoids resulted in significant clinical improvement, leading to eventual hospital discharge. This case highlights the complexity and diagnostic challenges of myxedema coma, emphasizing the importance of early recognition, appropriate application of diagnostic scoring systems, and describing key aspects of the proper management of this rare endocrine emergency, whose symptoms and clinical signs are nonspecific.

Keywords: endocrine emergency; hypothyroidism; myxedema coma; sepsis; side effects of amiodarone.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography of the chest: coronal view (panel A) and axial view (panel B).
Consolidation in the right upper, middle, and lower lobes is associated with mucoid impaction in the small airways of the latter. Subpleural opacities in the posterior fields of both lungs. Small bilateral pleural and pericardial effusions.
See this image and copyright information in PMC

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