Endocrine Abstracts

Background: Myxoedema coma although uncommon can be life-threatening in patients who are poorly compliant with levothyroxine replacement. Some of the precipitating factors include intercurrent respiratory infection, use of sedatives, and electrolyte imbalance such as hyponatremia(Wiersinga 2018). A 73-year-old man presented to the Hospital with face and tongue swelling, shortness of breath, and type 2 respiratory failure. His past medical history includes hypothyroidism, Obstructive sleep apnea syndrome (OSA), venous leg ulcers, Type 2 diabetes, prostate problems, and Atrial fibrillation. His current medications on table 2 below He initially received a CI esterase inhibitor for suspected angioedema and had some improvement in the Accident and Emergency Resuscitation room was transferred to the intensive care unit and intubated due to agitation and concerns about maintaining his airway. His blood test showed severe hypothyroidism likely due to poor compliance. He was treated with iv liothyronine(T3) and iv hydrocortisone. He was also treated for congestive cardiac failure. Chest X-ray showed bilateral pleural effusion. He developed hospital-acquired pneumonia for which he received iv antibiotics. His confusion improved with the improving thyroid function test table 1 below. He was discharged home on levothyroxine after prolonged hospital admission.

Discussion: Severe hypothyroidism presenting as myxoedema can lead to fatal outcomes. The mortality rate is around 30-60% (Wall, C 2000), and therefore early clinical diagnosis and timely treatment are important to ensure patient recovery and desired outcomes. The clinical manifestation of myxoedema coma is variable. Some of the clinical presentations include confusion, altered level of consciousness, hypothermia tiredness, generalized swelling, and constipation. The presented case had some of the above-mentioned clinical features and the swelling on his face and enlarged tongue were treated as suspected angioedema

Conclusion: Myxoedema coma is both a medical and an endocrine emergency. Early treatment using Liothyronine is important to get desired and better outcome for the patient. Ruling out Addisonian crisis and correcting hypothermia, hypotension, and other electrolytes imbalance contributes positively to patient care(Wiersinga 2018)