Endocrine Abstracts

Myxoedema Coma with NAFLD secondary to poorly controlled hypothyroidism. Myxoedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing function in multiple organs. It can culminate in severe, longstanding hypothyroidism or be precipitated by acute stressors such as infection, and surgery in patients with poorly controlled hypothyroidism. Moreover, there is a strong correlation between poorly controlled hypothyroidism and the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Although the mechanism of how the two interlink remains unclear. Herein we present a case of a patient with poorly controlled hypothyroidism which caused secondary NAFLD and culminated in myxoedema coma.

Case presentation: A 79-year-old woman presented to the emergency department after being confused and less responsive at home. Her background is Hypothyroidism with poor compliance with her medication, Hypertensive, and CVA. No history of alcoholism. On presentation, her vital signs were unremarkable apart from high blood pressure of 191/112. on examination she was disoriented, physical examination was remarkable for periorbital oedema and lower limb oedema. Abdominal ultrasound showed fatty liver, CT Angiogram showed an Enlarged thyroid gland with retrosternal extension. Myxoedema coma was diagnosed, which was treated with hydrocortisone, the loading dose of levothyroxine100 micrograms followed by 50 micrograms daily with an increase of 10 micrograms till reached 100 micrograms and liothyronine 10 micrograms twice per day were given. Over 10 days patient consciousness returned to normal as well liver enzymes.

Discussion/conclusion : Myxoedema coma is a medical emergency that requires urgent management. In our case, the precipitating factor was likely poor compliance with medication for her hypothyroidism. In the case presented here patient abdominal ultrasound showed fatty liver stranding, after excluding organic and other causes of Non-Alcoholic Fatty Liver Disease it was concluded that the most probable cause of NAFLD was due to the patient’s severe and poorly controlled hypothyroid. After starting Thyroxine Liver enzymes show marked improvement and return to normal levels. Based on the findings from this case we recommend screening for thyroid dysfunction in the patient that presents with non-alcoholic liver disease.