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Myxedema Coma

The life-threatening end-stage complication of severe and prolonged hypothyroidism.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Myxedema Coma?

Myxedema coma is a rare endocrine emergency in which untreated or undertreated severe hypothyroidism — combined with a serious trigger (infection, cold exposure, sedative drug, surgery) — reaches a life-threatening level. True coma is not always present; severe altered consciousness with multi-system failure dominates the picture.

Pathophysiology involves marked reduction of metabolic rate together with hypothermia, hypoventilation, hyponatremia, and impaired cardiac function. Mortality is 30-60% but can be reduced with early aggressive treatment.

Diagnosis is clinical; high TSH and low free T4 support the diagnosis. Thyroid hormone replacement should not be initiated without first ruling out adrenal insufficiency (cortisol measurement).

Symptoms

Confusion or coma
Hypothermia (body temperature <35°C)
Slow heartbeat (bradycardia) and hypotension
Slow breathing and CO2 retention (hypercapnia)
Swelling of the face, eyelids, and tongue (myxedema)
Cold and dry skin
Hyponatremia and hypoglycemia

Risk Factors

Long-standing untreated or inadequately treated hypothyroidism
Elderly women
Winter season and cold exposure
Infection, trauma, or surgery
Use of sedative, anesthetic, or narcotic drugs

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Onset of altered consciousness or extreme drowsiness in a known hypothyroid patient (EMERGENCY!)
  • Low body temperature, slow pulse, and cold skin together
  • Confusion in an untreated elderly patient during winter months

Treatment Methods

01
Intensive care unit monitoring and mechanical ventilation support (if needed)
02
IV levothyroxine (T4) loading dose followed by maintenance
03
Concurrent IV liothyronine (T3) is recommended in some protocols
04
Corticosteroids (hydrocortisone 100 mg IV): until adrenal insufficiency is excluded
05
Hypothermia management: passive rewarming (active rewarming may cause hypotension)
06
Correction of hyponatremia, hypoglycemia, and fluid-electrolyte imbalances
07
Broad-spectrum antibiotics if a triggering infection is present

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.