Endocrine Abstracts

A 70-year-old lady, with a background of primary hypothyroidism presented to the Emergency department with a 1 day history of confusion and drowsiness. On examination her HR was 58 bpm, temperature 28 degrees celsius. She was resuscitated with warm fluids and bair hugger, whilst also given broad spectrum intravenous antibiotics. Her blood results showed an AKI with creatinine of 213 and was treated for a NSTEMI with a troponin on admission of 1770, rising to 2190. ECG showed prolonged QTc with 1^st degree heart block. Her thyroid function tests on admission showed TSH 236.98, free T4 6.1, free T3 2.7. Thyroid peroxidase antibodies were strongly positive. Short Synacthen test was normal. A diagnosis of myxoedema coma was made and she was treated with IV Liothyronine and oral thyroxine and IV hydrocortisone. Due to severe obtundation, she required ITU admission with ventilatory and inotropic support. The dose of liothyroinine was carefully titrated, in view of risk of causing further ischaemia in view of presentation with NSTEMI. She made a good recovery, with TSH 1.07 and free T4 24.4 on discharge. She was discharged on oral Levothyroxine 175 micrograms, with education on the importance of good medication adherence. Myxoedema is an important life threatening manifestation of hypothyroidism, which can result in fluid retention, negative inotropism and chronotropism with cardiogenic shock, stupor and coma. In severe cases, the overall mortality is 25–60%. Prompt recognition and effective management of such patients is key to improving prognosis.