title: Myxedema Coma with Reversible Cardiopulmonary Failure: a Rare Entity in 21StCentury.
abstract: Myxedema coma, a rare entity in 21st century in developed nations, is a decompensated phase of hypothyroidism with high mortality rates. We describe a young woman with myxedema, who developed respiratory failure, congestive heart failure and significant pericardial effusion, some of the uncommon manifestations. Decreased cardiac contractility can result in cardiomyopathy and heart failure. As illustrated by this case, myxedema can also result in significant pericardial effusion due to increased vascular permeability. Myxedema can further be complicated by alveolar hypoventilation and respiratory failure secondary to the lack of central drive as well as respiratory muscle weakness. Prompt therapy with thyroid hormone replacement, glucocorticoid therapy, aggressive supportive care and management of the precipitating event can save lives and reverse the cardiopulmonary symptoms, as in our patient. Hence, physicians should have a high index of suspicion for myxedema coma in patients with unexplained cardiopulmonary failure. Our report is, therefore, aimed at bringing awareness about the rare but fatal manifestations of myxedema coma.
authors.affiliation: Department of Medicine, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Prajwal
authors.initials: P
authors.lastname: Dhakal
authors.affiliation: Department of Medicine, College of Medical Sciences, Bharatpur, Nepal.
authors.forename: Manisha
authors.initials: M
authors.lastname: Pant
authors.affiliation: Department of Internal Medicine, St. Alexius Medical Centre, Bismarck, North Dakota, United States of America.
authors.forename: Pranab Sharma
authors.initials: PS
authors.lastname: Acharya
authors.affiliation: Department of Medicine, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Sumit
authors.initials: S
authors.lastname: Dahal
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, Nebraska Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, United States of America.
authors.forename: Vijaya Raj
authors.initials: VR
authors.lastname: Bhatt