title: Myxoedema coma in the setting of hyperglycaemic hyperosmolar state.
abstract: Decompensated hypothyroidism is a rare endocrine emergency but a differential that should be considered in patients presenting critically unwell with systemic illness. We report a case of myxoedema coma in a woman presenting with respiratory failure, hypotension, hypothermia and a reduced level of consciousness, all of which are poor prognostic features in decompensated hypothyroidism. The patient was admitted to critical care for mechanical ventilation and cardiovascular support and treated with a combination of insulin, liothyronine and levothyroxine, making a good recovery. We wanted to highlight this case of myxoedema coma occurring in the context of a hyperglycaemic hyperosmolar state (HHS), as the former condition is normally associated with hypoglycaemia, hyponatraemia and hypo-osmolality. Decompensated hypothyroidism should be considered in presentations of HHS as well as with other metabolic derangements, as delays in thyroid hormone replacement are associated with poorer outcomes. It has multisystem effects challenging its recognition and we discuss potential complications and their management.
authors.affiliation: Anaesthesia and Intensive Care, Tameside Hospital NHS Foundation Trust, Lancashire, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Spyridoulias
authors.affiliation: Anaesthesia and Critical Care, Tameside Hospital NHS Foundation Trust, Lancashire, UK.
authors.forename: Muhammad Shakeel
authors.initials: MS
authors.lastname: Riaz
mesh_terms: D005260:Female; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007022:Hypotension / Q000209:etiology; D007035:Hypothermia / Q000209:etiology; D007328:Insulin / Q000627:therapeutic use; D008875:Middle Aged; D009230:Myxedema / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D012131:Respiratory Insufficiency / Q000209:etiology; D013974:Thyroxine / Q000627:therapeutic use; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D014284:Triiodothyronine; D013974:Thyroxine