UMEM Educational Pearls

Category: Misc

Title: Severe Hypothyroidism or Myxedema Coma

Keywords: Hypothyroidism, Myxedema, Treatment (PubMed Search)

Posted: 10/11/2008 by Michael Bond, MD (Updated: 6/25/2022)
Click here to contact Michael Bond, MD

Severe Hypothyroidism or Myxedema Coma

  • Mortality rate has been as high as 80% now 15-20% with aggressive treatment
  • Some common symptoms are:
    • Constipation
    • Depression
    • Lethargy
    • Dry, Brittle hair or Alopecia
    • Weight Gain
    • Cold Intolerance
    • Weight Gain
  • Treatment consists of:
    • Rule out aggravating cause (i.e.: infection)
    • Start IV levothyroxine dosing
      • Initial dose 400-500 mcg (Helps to saturate the thyroid receptors)
      • Daily dose 100 mcg/day
    • Consider starting Dexamethasone or doing a Cortisol stimulation test
      • Patients may also have adrenal insufficiency from primary pituitary failure or may have secondary adrenal suppression due to the severe hypothyroidism.  If dexamethasone is not provided they may develop severe adrenal insufficiency once you kick start their metabolism.