DOI: https://doi.org/10.36347/sasjm.2025.v11i05.015

Pages: 464-466

Myxedema coma (MC) is a rare and life-threatening endocrine emergency resulting from severe hypothyroidism, with a high mortality rate. It can develop in patients with long-standing undiagnosed hypothyroidism or be precipitated by an underlying medical or surgical condition. Due to its nonspecific presentation, MC is often misdiagnosed, even in patients exhibiting key signs such as hypothermia. This case illustrates the diagnostic challenges and clinical management of a 43-year-old man with no prior medical history, who was admitted to the emergency department in a comatose state with severe hypothermia and bradycardia. Further biochemical testing revealed profound undetectable T4 levels, a TSH concentration exceeding 205 mU/ml, hyponatremia at 121 mEq/L and CK elevation at 28 960 UI/L. No precipitating illness was identified. The myxedema coma score was calculated at 135 points, highly suggestive of diagnostic of myxedema coma, while the sequential organ failure assessment (SOFA) score was at 9. Treatment consisted of supportive care, including fluid resuscitation, vasopressors, mechanical ventilation, passive rewarming, thyroid hormone replacement (levothyroxine) at a dose of 300µg and glucocorticoid administration (hydrocortisone 50 mg IV every 6 hours). This case underscores the critical need for clinicians to maintain a high index of suspicion for hypothyroidism in at-risk individuals to facilitate early diagnosis and timely intervention, potentially improving patient outcomes.