Endocrine Abstracts

Background: Congenital hypothyroidism is rare and is screened for in the Philippines during the newborn period in order to prevent a treatable cognitive delay. Myxedema coma is a complication due to severe hypothyroidism resulting from failure of homeostatic processes, causing altered mental status, edema, and vital sign abnormalities. It is a rare, life-threatening complication of hypothyroidism, an estimated 0.22 per million new cases of myxedema coma are diagnosed each year.

Case Presentation: A 29-year-old female with a history of untreated hypothyroidism presented to the emergency department after being found on the floor unconscious. In the emergency department, the patient’s vital signs were remarkable for a body temperature of 35 C. The patient was also bradycardic to 51 beats per minute with stable blood pressure. On examination, the patient was stuporous, respond to painful stimuli with a GCS of 7 (E1V1M5). Physical examination was remarkable abnormal facies, short stature, and edema of extremities. Based on the history and all findings of clinical signs of hypothyroidism with alteration of consciousness, bradycardia and hypothermia, myxoedema coma was diagnosed and L-thyroxine therapy was promptly initiated. Thyroid function test results showed a free thyroxine (FT4) level of 0.1 ng/dl (0.70-1.48), free triiodothyronine (FT3) level of 1.53 pg/ml (1.71–3.71) and TSH level of >100 uIU/ml (0.35–4.94), and thyroperoxidase antibodies were negative. Thyroid ultrasonography demonstrated Thyroid Hypoplasia which raised suspicion for congenital hypothyroidism. Due to the altered level of consciousness, a nasogastric tube was inserted to allow the administration of oral medications. She was given oral levothyroxine 200 μg every 8 hours, together with intravenous hydrocortisone 100 mg every 8 hours. The patient was admitted to the ICU for close monitoring. Supportive measures were applied, including oxygen support, temperature control, empirical ceftriaxone therapy, and hydration. After 3 days in ICU, the patient was awake and alert. Blood and urine cultures showed no growth. The patient remained comfortable, alert, and oriented with no complaints. She was later discharged with oral 1 mg of levothyroxine daily and outpatient follow up.

Conclusion: Myxedema coma may be rare due to the currently available diagnostic tools and therapies, but it remains a life-threatening condition. In resource-limited settings, oral levothyroxine may be a suitable alternative to the intravenous formulation in the initial treatment of myxedema coma. Early diagnosis, administration of thyroid hormones, and supportive management are vital for a good prognostic outcome.