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.
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” Unfortunately, overlooking the myxedema component may have grave consequences.”
Or Grave’s consequences, amirite?
…
I’ll see myself out.
You make such a good point that unfortunately the name leads to diagnostic failure. I like your suggestion of referring to it as “decompensated hypothyroidism” instead. So much better. This was a great review, thanks for doing this!
Hi, thank you for your post. Do you know the frequency of generalized myxedema in decompensated hypothyroidism? You say it is uncommon, but how uncommon? Thank you!
I was wondering if you could shine some light on the validity of the free T4 measurement in setting of acute acidemia. Suppose the patient is ESRD with urgent need for dialysis K+ around 7.0. hypothermic (not environmental), bradycardic (certainly largely due to hyper K) hypotensive, LE non-pitting edema, QTc around 580. Random cortisol is normal, TSH is normal. T4 is low however. Can I rely on that T4 measurement? Lit search only describes chronic acidemia causing inaccurate T4 measurements. Assume no confabulating toxidrome present.
Thanks!