Myxedema Coma

  • Medical Author:
    Ruchi Mathur, MD, FRCP(C)

    Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What are the symptoms of myxedema coma?

When a patient presents with myxedema coma the following may be present:

  • the body temperature is usually abnormally low (hypothermia), the core temperature may be as low as 80 F (26.6 C);
  • severe mental changes including hallucinations, disorientation, seizures, and ultimately, deep coma;
  • significant swelling (edema) all over the body with swollen eyes and thickening of the tongue,
  • sparse, dry hair, and loss of the outer thirds of the eyebrows;
  • difficulty breathing;
  • collections of fluid around the lungs and heart (pleural effusion and pericardial effusions);
  • the heart may slow down and its ability to pump blood forward can be impaired;
  • the gastrointestinal tract does not function well and sometimes it becomes paralyzed, thereby necessitating surgery; and
  • blood test abnormalities are a result of the increased fluid in the body. For example, sodium levels drop because of dilution, which is caused by the body retaining extra water.

How is myxedema coma diagnosed?

Initial laboratory evaluation usually includes a test for thyroid function (TSH, T3 and T4 levels). Other blood tests, as well as heart and lung function testing, may also be needed.

What is the treatment for myxedema coma?

Treatment may include assisting the patient to breathe and warming them to raise the body temperature to normal. Often, antibiotics are started until it is certain that an infection is not present.

The method of replacing thyroid hormone in patients with myxedema coma is controversial. Many different approaches are used. In general, initial replacement is done by intravenous infusion, since the intestinal system may not be absorbing properly.

While common hypothyroidism without myxedema is usually treated with T4 replacement (the hormone produced in greatest quantity by the thyroid gland), in the case of myxedema coma, management is different. The thyroid gland also produces a small amount of another hormone, T3. This is the more metabolically active of the two hormones. In patients who are well, T4 is converted into T3 in the bloodstream. However, patients with myxedema coma are often so sick that this conversion is impaired. As a result, many doctors choose to treat these patients with T3 initially and start T4 therapy as well. Since T4 therapy can take a month or so to work, there is usually an overlap of these two hormones. Care is taken to avoid heart rhythm abnormalities (arrhythmias) and stress on the heart, which can be caused by replacing thyroid hormone too quickly, particularly in elderly patients.

While mild thyroid disorders can be managed by primary care physicians, myxedema coma is generally managed by a thyroid specialist (endocrinologist) because treatment can be complicated and critical.

Medically Reviewed by a Doctor on 2/19/2015

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