SHM Converge Scientific Abstract ePoster Gallery-Thyroid Emergency: Rare Case Myxedema Coma With Class 2 Hypoglycemia.

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This case report describes a rare thyroid emergency: myxedema coma (MC) with severe hypothyroidism presenting as hypoglycemia in a non-diabetic 45-year-old woman. MC is uncommon, with an incidence of about 0.22 cases per million per year, but it carries a high mortality rate of 25%–60%, making early recognition and treatment critical.<br /><br />The patient had a history of gastric sleeve surgery and total thyroidectomy for follicular thyroid carcinoma, and she was reportedly compliant with levothyroxine. She presented to the emergency department with 3 weeks of worsening fatigue, lethargy, exertional shortness of breath, cold intolerance, constipation, and bilateral leg edema. Her point-of-care glucose was 42 mg/dL, and laboratory testing showed markedly elevated TSH (129.7 mIU/L) with very low free T4 (0.2 ng/dL) and free T3 (0.5 ng/dL), consistent with severe hypothyroidism. Vital signs and exam findings, including bradycardia, hypothermia, slow speech, and non-pitting edema, supported the diagnosis. Using two established MC scoring systems, she scored in the range strongly suggestive of myxedema coma.<br /><br />She was treated promptly with an intravenous levothyroxine loading dose (500 mcg) and hydrocortisone 100 mg every 8 hours, and was admitted for close monitoring. Further history revealed a likely cause of treatment failure: she had been drinking cranberry and grapefruit juice shortly before taking levothyroxine, which may have interfered with absorption. Her past gastric sleeve surgery may have also contributed to malabsorption. After treatment, she returned to her baseline within 3 days.<br /><br />The report emphasizes three key learning points: myxedema coma is rare but life-threatening, medication counseling is important to prevent severe hypothyroidism, and hypoglycemia in non-diabetic patients should prompt evaluation for unusual underlying causes such as thyroid emergency.

Asset Subtitle

Naaiko Yorichika

Meta Tag

Author List Hoang C. Nguyen, Naaiko Yorichika, Quynh Thu Nguyen, Thanh D. Hoang, Zeyar Thet

Category Clinical Vignettes

Concept Myxedema Coma

Concept Severe Hypothyroidism

Concept IV Thyroid Hormone

Concept Stress-dose Hydrocortisone

Concept Thyroid Emergency

Distinguished Non-Finalist

Presenter Organization Wyckoff Heights Medical Center

Presenting Author Naaiko Yorichika

Track Adult

Keywords

myxedema coma

severe hypothyroidism

hypoglycemia

levothyroxine malabsorption

thyroid emergency

non-diabetic hypoglycemia

gastric sleeve surgery

total thyroidectomy

hydrocortisone treatment

bradycardia hypothermia

Myxedema Coma

Severe Hypothyroidism

IV Thyroid Hormone

Stress-dose Hydrocortisone

Thyroid Emergency