August 21, 2019
- Myxedema coma is severe, decompensated hypothyroidism with a very high mortality.
- Classic features include: decreased mental status, hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia, and hypoventilation
- Work up includes looking for and treating precipitating causes, most commonly infection as well as serum levels of TSH, T4 and cortisol
- Treat for the possibility of adrenal insufficiency with stress dose steroids such as hydrocortisone 100 mg IV
- The exact means of thyroid replacement is controversial. Definitely given 100-500 mcg levothyroxine and discuss the simultaneous administration of T3 with your endocrine and ICU teams.