Myxedema coma: A case report of pediatric emergency care

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Internal Medicine

Background:

• Myxedema coma (MC) is a rare, life-threatening complication of hypothyroidism, particularly in pediatric patients.
• No established clinical guidelines exist for managing pediatric MC.
• Hypothyroidism can present initially as MC in children with prolonged untreated disease.

Observation:

• A 6-year-old girl presented with coma and hypothermia following pneumonia.
• Laboratory results revealed severe hypothyroidism (low free T4, high TSH) and elevated thyroid antibodies.
• CT scan showed pneumonia with pleural and pericardial effusions.

Findings:

• The patient was diagnosed with MC, autoimmune hypothyroidism, pneumonia, and sepsis.
• Treatment included gastric levothyroxine, intravenous dexamethasone, and antibiotics.
• Clinical improvement, including restored consciousness and normalized temperature, occurred within 2 days of levothyroxine initiation.

Implications:

• MC should be suspected in pediatric patients presenting with altered mental status, hypothermia, and cardiovascular instability.
• Autoimmune thyroiditis is a potential cause of hypothyroidism in children.
• Gastric levothyroxine administration (100 mcg/m²) is a viable treatment option for pediatric MC.