SHM Converge Scientific Abstract ePoster Gallery-Hidden Myxedema: Supraglottic Edema Causing Airway Obstruction in Myxedema Coma

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This case describes a 62-year-old woman with stage 5 chronic kidney disease and long-standing hypothyroidism who presented with subacute slowed mentation, fatigue, constipation, cold intolerance, dry skin, hallucinations, and bradycardia. Laboratory testing showed markedly elevated TSH and concern for severe hypothyroidism/myxedema coma. Her Myxedema Coma Score was 45, which is supportive of the diagnosis.<br /><br />Myxedema coma is the most severe form of hypothyroidism and is associated with high mortality, making early recognition critical. It typically presents with altered mental status, hypothermia, and myxedematous changes, and can also cause respiratory failure from depression and hypercapnia. In this patient, the clinical course worsened with increasing somnolence, hypercapnia, and development of a muffled voice and throat fullness.<br /><br />Imaging and airway evaluation revealed an important, rare complication: supraglottic myxedema causing diffuse edema of the neck, larynx, and airway narrowing. Flexible laryngoscopy confirmed significant vocal cord edema. Because of impending airway compromise, she was transferred to the ICU and intubated for airway protection.<br /><br />Treatment included IV levothyroxine, liothyronine, glucocorticoids, and aggressive diuresis. She improved, was extubated by day 10, and discharged on day 15 with an increased levothyroxine dose.<br /><br />The key teaching points are that myxedema coma may present without a classic precipitating event, and profound hypothyroidism can rarely involve supraglottic structures, creating a difficult airway. Close monitoring of respiratory status and airway patency is essential, and clinicians should consider imaging and ENT evaluation when airway obstruction is suspected.

Asset Subtitle

Kelsey Perry

Meta Tag

Author List Amy Munchhof, Kelsey Perry

Category Clinical Vignettes

Concept Myxedema Coma

Concept Upper Airway Obstruction

Concept Airway Assessment

Concept IV Thyroid Hormone

Concept Airway Management

Distinguished Non-Finalist

Presenter Organization Indiana University School of Medicine

Presenting Author Kelsey Perry

Track Adult

Keywords

myxedema coma

severe hypothyroidism

chronic kidney disease

altered mental status

bradycardia

supraglottic myxedema

airway compromise

laryngeal edema

flexible laryngoscopy

levothyroxine treatment

Myxedema Coma

Upper Airway Obstruction

Airway Assessment

IV Thyroid Hormone

Airway Management