SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Myxedema Coma in a Patient With Disseminated Tuberculosis

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This case describes an 80-year-old woman with disseminated tuberculosis who developed myxedema coma during hospitalization for right third DIP osteomyelitis. She initially presented with joint edema and erythema, but family and clinical history also revealed several weeks of waxing and waning confusion, low energy, and poor oral intake. Her TB treatment had included isoniazid, ethambutol, and pyrazinamide, with rifampin stopped two months earlier because of drug-induced liver injury.<br /><br />After admission, she became lethargic, profoundly hypotensive, bradycardic, and hypothermic—classic signs of myxedema coma. Thyroid studies showed severe hypothyroidism (TSH 207 mcU/mL, free T4 0.22 ng/dL), whereas prior labs while she was receiving rifampin had shown only subclinical hypothyroidism. She was diagnosed with myxedema coma and transferred to the ICU. Because of concern for adrenal insufficiency, an ACTH stimulation test was performed and was normal. She was treated with IV levothyroxine and IV liothyronine.<br /><br />The authors suggest that rifampin likely contributed to the patient’s hypothyroidism, which was then worsened by acute infection from Staphylococcus epidermidis osteomyelitis, precipitating myxedema coma. TB infiltration of the thyroid was considered but deemed less likely because her disseminated TB was otherwise improving. This case highlights that anti-tuberculosis medications can be associated with hypothyroidism and that severe infection can trigger decompensation.<br /><br />Myxedema coma is a rare but life-threatening endocrine emergency with mortality rates of 30% to 60%. Early recognition is crucial, especially in older patients with altered mental status, hypotension, or hypothermia. The main treatment is thyroid hormone replacement, usually IV T4, with T3 often added because of its faster biologic effect and impaired peripheral conversion of T4 during severe illness. The patient’s thyroid labs normalized by hospital day 11, and her mental status gradually improved before discharge on hospital day 66.

Asset Subtitle

Nikita G. Deshpande

Meta Tag

Author List Magdy El-Din MD, Nikita G. Deshpande

Category Clinical Vignettes

Concept Myxedema Coma

Concept Levothyroxine Therapy

Concept Hypothyroidism

Concept Altered Mental Status

Concept IV Thyroid Hormone

Distinguished Non-Finalist

Presenter Organization University of Chicago Pritzker School of Medicine

Presenting Author Nikita G. Deshpande

Track Adult

Keywords

myxedema coma

hypothyroidism

rifampin

tuberculosis

osteomyelitis

levothyroxine

liothyronine

hypothermia

bradycardia

adrenal insufficiency

Myxedema Coma

Levothyroxine Therapy

Hypothyroidism

Altered Mental Status

IV Thyroid Hormone