Critical Consideration of Myxedema Coma in the Postoperative Setting: A Case Report

Abstract

Myxedema coma is a rare but highly fatal condition with reported mortality >40%-50%. Early recognition and prompt treatment are critical for survival. Here we describe a case of possible postoperative myxedema coma after subacute neck hematoma evacuation after hemithyroidectomy in a patient on concurrent amiodarone therapy. Symptoms included somnolence, hypothermia, and prolonged QTc with torsades de pointes resistant to magnesium therapy requiring defibrillation and overdrive pacing. Consideration of the possible diagnosis of myxedema coma resulted in prompt therapy and symptom resolution within 48 hours. Thyroid disorders, although rare, should be considered in the postoperative setting.

Endocrine emergencies in anesthesia

“…On the other hand, myxedema coma can present as altered mental status, bradycardia, hypotension, hypothermia, and nonpitting edema and, if untreated, can lead to cardiovascular collapse and death [47]. Myxedema coma is precipitated by infection, cold, trauma, surgery, noncompliance with thyroid hormone, or treatment with amiodarone and lithium [48]. A low serum-free T4 with elevated TSH confirms a diagnosis of primary hypothyroidism, whereas a low serum-free T4 and TSH serum concentration that is not appropriately elevated prompts a diagnosis of secondary or tertiary hypothyroidism.…”