Myxedema Coma – 7/27/17

Most common presentation

  • Altered mental status
  • Hypothermia
  • Precipitating event
  • **Myxedema and coma do not have to be present**

Physical exam findings

  • Hypothermia
  • Bradycardia
  • Hypotension
  • Cool skin
  • Diffuse soft tissue swelling without pitting
  • Altered mental status

Lab abnormalities

  • Hyponatremia
  • Elevated CK
  • Elevated transaminases
  • Hypoglycemia
  • Elevated TSH with frankly low T4 level

Treatment

  • IV levothyroxine
  • Use of T3 is controversial
  • Stress dose steroids because of concern for precipitating adrenal insufficiency
  • Supportive measures

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