Amiodarone-induced myxoedema coma as a rare differential diagnosis of consciousness disturbance

Abstract

Myxoedema coma is an uncommon and life-threatening endocrine emergency with a high mortality rate. This entity is the extreme expression of severe hypothyroidism and the cardinal features are decreased mental status and hypothermia. Diagnosis is challenging and a high index of suspicion is crucial because it allows an early recognition of this condition and prompt initiation of supportive measures along with adequate thyroid replacement therapy. Herein, we report an extremely rare case of myxoedema coma secondary to amiodarone in a 90-year-old female with no previous history of thyroid disease, which was successfully treated with thyroid hormone replacement. Although its rarity, we emphasize that myxoedema coma should be included in the differential diagnosis of consciousness disturbances, particularly in patients under amiodarone therapy.

Amiodarone Induced Myxedema Coma: A Systematic Review of Case Reports

“…The critical appraisal result for the case report shows a good quality of research evidence. One study scored (100%) for all questions [10], and four case reports scored 87.5% [2,16]. Also, ve case reports scored 75% [17][18][19][20][21].…”

“…[Please insert Table 3 here] Altered mental status was also represented in ten case reports (34.5%) [10,16,17,[20][21][22][23][24][25][26], and eight cases (27.6%) reported bradycardia as a subsequent recurrent symptom among patients [2,10,16,18,22,[24][25][26]. However, hypothermia and hypotension were reported about in half of the cases.…”

“…However, hypothermia and hypotension were reported about in half of the cases. Additionally, nine cases (75%) reported that the patients had no previous thyroid dysfunction [10,17,20,21,23,25, 26], while three case reports (25%) their patients had hypothyroidism [18,22,24]. Half of the included cases (50%) reported T3 and T4 levels [2,17,20,21,24,25], while the remaining did not [10,16,18,22,23,26].…”

“…For TSH, almost all cases reported the TSH level. Four cases (33.3%) pointed out TSH results between 50 and 100 mIU/L [16,18,22,25], the other four reported more than 100 mIU/L [2,20,21,24], and three (25%) reported TSH between 14 and 44 mIU/L [10,17,26]. Upon diagnosis with myxedema coma, treatment in hospitals includes levothyroxine and hydrocortisone.…”

“…Also, if Amiodarone doses are greater than 200 mg/day, amiodarone-induced myxedema coma (AIM) or hypothyroidism is observed three months to 2 years after the drug starts (Kuroski et al, 2019). cases of a myxedema coma under amiodarone therapy with no previous history of thyroid disease were reported [10].…”