7 Pearls re. Myxedema Coma

Myxedema Coma is a medical emergency.

1. Myxedema Coma is a clinical diagnosis and treatment should not be delayed until laboratory confirmation.

2. Even if the enteral route is available, IV Thyroid hormone (T4 or T3) replacement is needed as GI absorption is unreliable.

3. T4 is preferable if underlying cardiac co-morbidity is suspected.

4. Steroids should be started after a random cortisol level is drawn.

5. Adding prophylactic antibiotics is not a bad idea.

6. Hypotension is not due to volume depletion, so avoid aggressive fluid replacement.

7. A thermometer that can record below 90°F (32.2 C) is preferable.

#endocrinology 

Further readings:

1. Elshimy G, Chippa V, Correa R. Myxedema. 2023 Aug 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 31424777. 

 2. Wall CR. Myxedema coma: diagnosis and treatment. Am Fam Physician. 2000 Dec 1;62(11):2485-90. PMID: 11130234.