Myxedema Coma

Extreme, life-threatening hypothyroidism

Definition

Myxedema coma is the most severe form of hypothyroidism, characterized by decompensated thyroid function with multi-organ failure. It has high mortality (30 to 60%) without prompt treatment.

Precipitants

Infection
Cold exposure
Trauma, surgery
Medications (opioids, sedatives)
Missed thyroid hormone doses

Clinical Features

Hypothermia, bradycardia, hypotension, hypoventilation, hyponatremia, hypoglycemia, altered mental status, coma. Classic 'myxedematous facies' with puffy, non-pitting edema of face.

Emergency Management

Airway, breathing, circulation
IV levothyroxine loading dose
IV hydrocortisone (in case of concurrent adrenal insufficiency)
Warm blankets for hypothermia (passive rewarming)
IV fluids cautiously (risk of overload)
Treat precipitant (antibiotics for infection)

NCLEX Relevance

Priority: levothyroxine + corticosteroid. Avoid rapid rewarming.