Postoperative myxoedema coma

Hypothyroidism is a commonly diagnosed endocrine disorder in medicine. Hyponatraemia is reported in up to 10% of hypothyroid patients, although it is usually mild and rarely causes symptoms. Myxoedema coma is a rare manifestation of hypothyroidism and it can be lethal if it goes undiagnosed and untreated. Our patient presented with an acute manifestation of probable long-standing, but undiagnosed, hypothyroidism. She was asymptomatic but when subjected to surgery (identifiable stress factor) it precipitated as myxoedema coma. Stressful situations such as surgery or infection are the usual precipitating factors for myxoedema coma. The patient responded well to treatment with levothyroxin, 0.9% saline infusion and other general supportive measures. Judicious use of intravenous saline to correct hyponatraemia is important. Correction with 3% normal saline should be carried out with great caution, as rapid correction with 3% normal saline can lead to central pontine demyelination.