SHM Converge Scientific Abstract ePoster Gallery-Myxedema Coma: Endocrine Emergency With Multiorgan Involvement and Hemodynamic Instability

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This case report describes a 64-year-old woman who presented unresponsive with agonal breathing, slurred speech, oral secretions, profound bradycardia, hypothermia, hypoxia, and altered mental status. Her history included hypothyroidism, seizures, breast cancer, anxiety/agoraphobia, tobacco use, and a prior overdose. Initial labs showed hyponatremia, severe hypothyroidism (TSH 40, very low T4), elevated CK, respiratory acidosis, and positive benzodiazepines on toxicology. Chest imaging showed pulmonary edema with pleural effusions and bibasilar atelectasis, and echocardiography revealed preserved systolic function with diastolic dysfunction.<br /><br />She was intubated for airway protection, treated with atropine for bradycardia, norepinephrine for hypotension, IV diuretics, nebulizers, and empiric steroids. Continuous EEG did not show seizure activity. She was started on IV levothyroxine and solumedrol, with rapid improvement in mental and clinical status over the next day. She was successfully extubated, and thyroid function began improving. The patient later reported that agoraphobia prevented her from picking up her levothyroxine, contributing to medication nonadherence.<br /><br />The report emphasizes that myxedema coma is a rare but life-threatening endocrine emergency, with mortality as high as 30–50%. It typically affects older women and may present with confusion, lethargy, or coma, along with hypoventilation, hypothermia, and hemodynamic instability. Because airway compromise and multisystem dysfunction can occur, early recognition and ICU-level monitoring are essential. The authors stress the importance of considering severe hypothyroidism in the differential diagnosis of acute encephalopathy and highlight psychosocial barriers to medication adherence as an important factor in prevention and follow-up.

Asset Subtitle

Shijo Benjamin

Meta Tag

Author List Shijo Benjamin

Category Clinical Vignettes

Concept Myxedema Coma

Concept Severe Hypothyroidism

Concept Altered Mental Status

Concept Levothyroxine

Concept Hypothermia

Distinguished Non-Finalist

Presenter Organization St. Luke's University Health Network

Presenting Author Shijo Benjamin

Track Adult

Keywords

myxedema coma

severe hypothyroidism

altered mental status

bradycardia

hypothermia

respiratory acidosis

levothyroxine

intensive care

medication nonadherence

agoraphobia

Myxedema Coma

Severe Hypothyroidism

Altered Mental Status

Levothyroxine

Hypothermia