Myxoedema coma

Presents as an exacerbation of the features of hypothyroidism (e.g. hypothermia, coma, bradycardia, metabolic and respiratory acidosis, anaemia). There may be a precipitating factor (e.g. cold, infection, surgery, myocardial infarction, CVA, central nervous system depressant drugs). Diagnosis is confirmed by thyroid function tests.

Management

• Treatment of the complications of severe hypothyroidism (e.g. hypotension, heart failure, hypothermia, bradycardia, seizures) is more important than thyroid hormone replacement.

• Thyroxine replacement should be with low doses (0.1-0.2 mg PO or PR unless ischaemic heart disease is possible, then start at 0.25 mg).

• There are no definite advantages to using T3 replacement, high dose replacement regimens or intravenous treatment.

• Steroids (hydrocortisone 100 mg qds IV) should be given since coexisting hypoadrenalism is masked by myxoedema.

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