SHM Converge Scientific Abstract ePoster Gallery-Beware Amiodarone-Induced Myxedema Coma

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An 88-year-old woman on amiodarone for atrial fibrillation presented after a witnessed cardiac arrest with prolonged downtime and ROSC. She was profoundly hypothermic, bradycardic, hypotensive, and edematous, with labs showing severe hypothyroidism (TSH 110 uIU/mL, low free T4), anemia, thrombocytopenia, hyponatremia, and acute kidney injury. Chest imaging suggested pneumonia, and she had recently been treated for a resistant UTI, which likely served as a precipitating stressor.<br /><br />In the ED, she suffered a second arrest with PEA and was resuscitated. She was admitted to the cardiac ICU, where she required transcutaneous pacing followed by a temporary transvenous pacemaker. Clinicians diagnosed severe amiodarone-induced hypothyroidism leading to myxedema coma, worsened by infection. Treatment included stopping amiodarone, IV levothyroxine, IV hydrocortisone, and broad-spectrum antibiotics. Her thyroid function normalized, she regained sinus rhythm without pacing, sedation was weaned, and she was successfully extubated. She was later transitioned to oral levothyroxine and discharged with endocrinology follow-up.<br /><br />The case highlights that amiodarone can cause thyroid dysfunction in 15–20% of users, regardless of prior thyroid disease. Myxedema coma is a life-threatening endocrine emergency characterized by severe hypothyroidism with systemic decompensation, often presenting with hypothermia, altered mental status, bradycardia, and a triggering event such as infection. Because mortality approaches 40%, early recognition and treatment are critical, and thyroid function should be monitored closely in patients receiving amiodarone.

Asset Subtitle

Ivana Ilic

Meta Tag

Author List Ivana Ilic

Category Clinical Vignettes

Concept Thyroid Dysfunction

Concept Myxedema Coma

Concept Amiodarone

Concept Levothyroxine

Concept Hypothyroidism

Distinguished Non-Finalist

Presenter Organization Northwell

Presenting Author Ivana Ilic

Track Adult

Keywords

amiodarone

myxedema coma

hypothyroidism

cardiac arrest

bradycardia

hypothermia

atrial fibrillation

temporary pacemaker

infection

levothyroxine

Thyroid Dysfunction

Myxedema Coma

Amiodarone

Levothyroxine

Hypothyroidism