Endocrine Abstracts

Introduction: Since the thyroid myxedema coma is rarely seen nowadays, its diagnosis can be overlooked.

Case: The patient with tracheostomy who underwent total laryngectomy and bilateral neck dissection and radiotherapy (RT) at the neck region 10 years ago due to Larynx cancer was admitted to the intensive care unit the diagnosis periorbital edema, hypotension, hypothermia, consciousness disorder and pneumosepsis. Treatment was started for Acinobacter, which was produced in the blood culture of the patient. The patient was found to have tongue growth and diffuse body edema and other hypothyroid findings. TSH: 52 (N: 0.27–4.2 mIU/l) free T4: 0.039 (N: 0.93–1.7 mIU/l), free T3: 0.527 (N: 2–4.4 mIU/l) was found in laboratory tests for suspected hypothyroidism. In thyroid ultrasonugraphy, both lobe size increased and heterogeneity in parenchyma. When these findings were evaluated together, the patient was accepted as hypothyroidism coma. IV levothyroxine was demanded to be introduced in our country, but 200-400 mcg/day oral LT4 and iv hydrocortisone treatment was started with 100 mg every 6 hour intervals. After treatment was begun, freee T4 levels reached normal levels 3 weeks later (1st 0.139 mIU/l, 2nd 0.5 mIU/l, 3rd 1.43 mIU/l). The patient showed significant improvement in hypothermia, hypotension and tongue swelling. However, the patient died because of DIC (disseminated intravascular coagulation) developed during the follow-up of the patient.

Conclucion: As the absorption of reduced oral levothyroxin due to edema from the bowel will delay the increase in free T4, faster euthyroidism can be achieved with IV levothyroxin preparations in the mix edema coma. On the other hand, it should be kept in mind that hypothyroidism may develop in patients receiving RT in the neck area and the patient should be kept in follow-up.