Endocrine Abstracts

Introduction: Myxedema coma (MC) is a rare life-threatening form of hypothyroidism most often seen in patients with incompletely treated or unknown hypothyroidism exposed to stressful conditions (surgery, infections, hypothermia, trauma).

Case report: We report the case of a 58-years-old woman hospitalized for coma in a peripheral hospital after a severe respiratory infection. Two days after, patient’s condition was worsening and she was transferred to a Universitary Hospital, where myxedema coma was suspected (history of untreated autoimmune hypothyroidism, apparently normal temperature – 36 °C despite the infection, bradycardia, hypotension, hypoventilation, hypercapnia, generalized edema). Biological findings showed respiratory acidosis without hyponatremia or other abnormalities. Very low FT₄ (<1 pmol/l) with high TSH (32 μIU/ml) confirmed MC. Intensive therapy (fluid replacement, dopamine, orotracheal intubation with oxygenotherapy) and hormonal therapy: 400 μg thyroxine by nasogastric tube, concomitant with hydrocortisone (HHC) 100 mg/6 h, improved patient’s status. Coma became superficial and 4 days after, having spontaneous respiration, normal gasometria and hemodynamic data, she was transferred in the Department of Endocrinology. Treatment included oral L-thyroxine (100 μg/day), HHC, antibiotics. Edematous syndrome and cognitive function improved, although some confusional features persisted (Hashimoto’s encephalopathy).

Discussion: Owing to the rarity of myxedema coma there are very few studies evaluating the efficacy of treatment and the evolution. Knowing its severe prognosis, it is important to promptly treat the patients with myxedema coma, even when the diagnostic is not certain. Nowadays the mortality rate decreased from 80% to 20–40% thanks to improved diagnostic testing, advances in intensive care, and increased awareness of physicians. Our happy ending story illustrates this improvement.