Myxedema coma is a misleading misnomer. Most patients don't have non-pitting edema (myxedema), nor are they frankly comatose. The best way to think about this disease is simply decompensated hypothyroidism. Patients with under-treated or untreated hypothyroidism have no metabolic reserve. Stressors may easily push them into multi-organ failure.
Myxedema coma is easily missed, because it will generally be associated with other physiologic stressors (e.g. sepsis, cold environmental exposures, surgery, burns). This can create a confusing combination of pathophysiologies, which often won't obviously be related to the thyroid. Unfortunately, overlooking the myxedema component may have grave consequences.
The IBCC chapter is located here.
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