|Classification and external resources|
Myxedema coma is a state of decompensated hypothyroidism. The patient may have lab values identical to a "normal" hypothyroid state, but a stressful event (infections, MI, stroke, drugs, etc.) precipitates the myxedema coma state, usually in the elderly. Primary symptoms of myxedema coma are altered mental status and hypothermia. Hypoglycemia, hypotension, hyponatremia, hypercapnia, hypoxia, bradycardia, and hypoventilation may also occur. Myxedema, although included in the name, is not necessarily seen in myxedema coma.
Mechanical ventilation if there is significant hypoxia.
Determine initial cortisol level, and administer corticosteroids (hydrocortisone at 5-10 mg/h).
Gradual warming with blankets; an external heating source should not be used.
Consider starting antibiotic prophylaxis until cultures come back, since infection is often the precipitating cause.
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