SHM Converge Scientific Abstract ePoster Gallery-Thyroid Emergency

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This case report describes <strong>myxedema coma</strong>, a rare but life-threatening complication of <strong>severe untreated hypothyroidism</strong>. It carries a high mortality rate, so <strong>early recognition and immediate treatment</strong> are critical.

A <strong>77-year-old man</strong> with a history of bladder cancer and no primary care follow-up for <strong>11 years</strong> presented to the emergency department with <strong>4–6 weeks of worsening mental status</strong>, with a sharp decline over the previous week. He also had <strong>fatigue, constipation, decreased oral intake, and oliguria</strong>. On arrival, he was profoundly ill with <strong>hypothermia (27°C)</strong>, <strong>marked bradycardia (31–40 bpm)</strong>, and <strong>hypotension</strong>. Laboratory testing confirmed severe hypothyroidism with <strong>TSH 51.22 mIU/mL</strong>, <strong>free T4 0.30 ng/dL</strong>, and <strong>free T3 18 pg/dL</strong>.

Because of his altered mental status and airway risk, he was <strong>intubated and placed on mechanical ventilation</strong>. Treatment included <strong>IV levothyroxine 300 mcg loading dose, then 100 mcg IV daily</strong>, plus <strong>IV liothyronine 2.5 mcg every 8 hours</strong>. He also received <strong>stress-dose hydrocortisone 50 mg IV every 6 hours</strong>, which was tapered as he stabilized. After two weeks, levothyroxine was switched to the oral route.

During hospitalization, his <strong>mental status improved significantly</strong>, though he had <strong>mild confusion at discharge</strong>.

The discussion highlights that myxedema coma commonly presents with <strong>altered mental status, hypothermia, bradycardia, hypotension, hyponatremia, and hypoventilation</strong>. Management requires <strong>supportive care, parenteral thyroid hormone, glucocorticoids</strong>, and treatment of any precipitating illness.

Asset Subtitle

Karen A. Clarke

Meta Tag

Author List Karen A. Clarke, Sathyabama Naidu

Category Clinical Vignettes

Concept Myxedema Coma

Concept Hypothyroidism

Concept Levothyroxine Therapy

Concept Altered Mental Status

Concept Hypothermia

Distinguished Non-Finalist

Presenter Organization Emory University

Presenting Author Karen A. Clarke

Track Adult

Keywords

myxedema coma

severe hypothyroidism

altered mental status

hypothermia

bradycardia

hypotension

levothyroxine

liothyronine

hydrocortisone

mechanical ventilation

Myxedema Coma

Hypothyroidism

Levothyroxine Therapy

Altered Mental Status

Hypothermia