Endocrine Abstracts

61 years old female with multiple comorbidities such as ckd-3, Trans abdominal hysterectomy and oophorectomy for endometrial cancer, complicated by entero-cutaneous fistula, ileal conduit and cholecystectomy.

She presented with generally unwell, nausea, vomiting, confusion.

On Examination she was bradycardic, low gcs, hypotensive and hypothermic.

The metabolic causes for confusion was excluded, anion gap was normal and myxedema coma was suspected and started on i/v triiodothyronine. She was reviewed by critical care and deemed unsuitable for critical care due to multiple comorbidities.

The investigations were as follows,

Tsh>120, free T₄−2.3, free T₃ <1, cortisol-920, wcc-9.8, na-141, k-3.5, creatinine-243, TPO Antibody->1300. Abg showed –ph-70.4, hco3-12, po2-6.26, pco2-6.26.

Patient improved with i/v thyroxine (T₄) and and started on oral T₄ with a dose of 1.7 μg/kg as divided doses due to previous bowel surgery and short bowel. Her tft improved and patient was discharged for follow up in endocrine clinic.

Myxedema coma has high mortality if not treated promptly. Although patient should be managed in a ITU settings ideally, supportive measures are of paramount importance in the treatment of life threatening illness.