Myxoedema coma is a rare but life-threatening condition that occurs due to thyroid insufficiency, mainly seen in elderly patients. It is similar to adrenal insufficiency. Predisposing factors include sepsis, CVA, CCF, MI, and GI bleeding. Symptoms include low body temperature, low blood pressure and pulse, low sodium and glucose levels, hyperventilation, convulsions, coma, and potentially death. Management involves moist oxygen inhalation, IV fluids, warming the patient slowly with blankets, broad spectrum antibiotics, levothyroxine administered IV or via nasogastric tube, hydrocortisone, hypertonic saline if severe hyponatremia,

1. Myxoedema Coma

2. •Similar to adrenal insufficiency
•Def. It is rare but life threatening
condition. It occurs from thyroid
insufficiency almost seen in
elderly subject

3. Q. Difference of hyperthermos and fever
•Fever = Hyperthermos + Change in hypothalamic set
point

4. Predisposing factor :-
• Sepsis
• CVA
• CCF, MI
• GI bleeding
• exposure to cold

5. Symptom :-
• ↓ ˚ C (Temperature)
• ↓BP, ↓Pulse
• ↓ Na+
• ↓ Glucose
• Hyperventilation
• Convulsion
• Coma
•Even death

6. Management :-
• Moist O2 inhalation
• IV fluid with NS
• Warming of the patient (slow by covering the
patient with blanket)
(Rapid warming would cause cardiac collapse)

7. iv) Brood spectrum antibiotic
Inj. Levothyroxine 500 µg iv. bolus
↓
Then 50 – 100 µg i.v. daily
Inj. Levothyroxine 20 µg i.v. stat
↓
10 µg i.v. 8 hourly
If I.V. line not established, levothyroxine can be given by naso-
gastric tube

8. v)Inj. Hydrocortisone, Na hemisuccinate –
100 mg stat
↓
100 mg IV 6-8 hourly till patient able to drink
vi)If severe hyponatraemia Normal 135 – 149µeq/lit
(<120 µeq/lit)
→ hypertonic saline (3%)

9. vii)Severe hypoglycaemia N– Fasting <110 PP <140
< 50 Fasting
↓
25% dextrose
viii)Persistent hypercapnia → Patient to be put on ventilator

10. Monitoring
1. Pulse, BP, Urine output
2. T3, T4
3. Na, K
4. Urea, Creatinine
5. arterial blood gas analysis