Management of Myxedema Coma

Abstract

Myxedema coma is the most severe manifestation of hypothyroidism. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a clinical challenge. It is typically caused by a precipitating event in an untreated or partially treated patient. Nearly every organ system is impaired in myxedema coma with varying degrees of severity. Depressed mental status and hypothermia are nearly universal. Severe hemodynamic and respiratory compromise can occur. Airway complications are rare but can be life threatening. Once the diagnosis is suspected, treatment should be initiated without delay. Thyroid hormone treatment, combined with ventilatory and hemodynamic support in the intensive care unit setting has improved the high mortality. The lack of controlled trials makes the optimal and most effective choice of thyroid hormone preparation controversial. Most patients can be managed with thyroxine alone, given intravenously at a loading dose, followed by standard oral regimen once clinical improvement is noted and adequate gastrointestinal motility is confirmed.