Successful treatment of myxedema coma using levothyroxine and liothyronine in the setting of adrenal crisis and severe cardiogenic shock in a patient with apparent primary empty sella

Elghawy, Omar; Hafey, Alexander C.; McCartney, Christopher R.; Steinman, Jeremy

doi:10.1016/j.jecr.2021.100095

Cited by 1 publication

(1 citation statement)

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“…In adrenal insufficiency biochemical markers show metabolic acidosis, hyperkaliemia, hyponatremia, and hypoglycemia. The administration of glucocorticoids first before other treatments is vital due to hypoadrenalism being a major risk factor for mortality and may co-exist with severe hypothyroidism [9]. In the above patient, however, cortisol was within normal range.…”

Section: Discussionmentioning

confidence: 84%

Myxedema Coma Precipitated by Sepsis in a Patient With a Complex Mental Health History

Amin¹,

Pabani²,

Lohano³

et al. 2023

Cureus

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Myxedema coma is a rare and life-threatening manifestation of severe hypothyroidism. Myxedema refers to altered mental status observed in these patients. Clinical characteristics observed include hypothermia, bradycardia, respiratory failure, hyponatremia, and altered mental status. We present the case of a 57-yearold female who was brought into the hospital with a history of collapse and a long lie. On initial assessment, she was hypothermic, hypotensive, bradycardic, and hypoglycemic with elevated infection markers, acute kidney injury, and electrolyte derangement. Her thyroid function tests on admission were severely impaired with a TSH (thyroid stimulating hormone) level of 144.46 mU/L and Free T4 (thyroxine) levels of 3.4 pmol/L. She was admitted to the intensive care unit and was started on intravenous antibiotics, intravenous liothyronine, oral levothyroxine, and intravenous hydrocortisone. Initially, her hypothermia and bradycardia were slow to respond to treatment measures, but following the introduction of liothyronine, she showed marked improvement. Over the next few days, her infection markers improved, her acute kidney injury resolved, and her thyroid function tests normalized. Liothyronine was stopped after 6 days, levothyroxine was continued at her regular dose of 175 micrograms, and she was safely discharged with outpatient endocrinology follow-up.

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Section: Discussionmentioning

confidence: 84%