Day #154 - Severe hypothyroidism (Myxedema Coma)

Today we discussed a case of severe hypothyroidism presenting with impaired cognition, bradycardia and hypothermia.

We discussed the treatment of severe hypothyroidism/myxedema coma:

• Supportive care
• IV levothyroxine 200-500mcg then 100mcg q24h until improving then oral 1.6mcg/kg
  
• After obtaining ACTH, cortisol levels, strongly consider stress dose steroids until concommitant adrenal insufficiency is excluded
• Look for precipitant (infection, MI, other)
• Empiric antibiotics for possible sepsis while awaiting cultures
  

This article discusses the polyglandular autoimmune syndromes.