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Myxoedema Coma Masquerading as Acute Stroke.

Christopher Butter1, Nazia Rashid1, Rumaisa Banatwalla1

  • 1St Peter's Hospital, Lyne, Chertsey, Surrey, UK.

European Journal of Case Reports in Internal Medicine
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PubMed
Summary
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Myxedema coma, a critical endocrine emergency, can mimic stroke and sepsis. Prompt recognition and thyroid hormone replacement are vital for patient survival.

Keywords:
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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Emergency Medicine

Background:

  • Myxedema coma is a life-threatening endocrine emergency.
  • It arises from overwhelmed physiological adaptations in untreated hypothyroidism.
  • Mortality rates remain high, up to 50%, even with prompt treatment.

Purpose of the Study:

  • To describe the management of a patient with myxedema coma.
  • To highlight its presentation mimicking acute stroke and 'cold sepsis'.

Main Methods:

  • Case report detailing patient management.
  • Review of diagnostic and therapeutic strategies for myxedema coma.

Main Results:

  • Myxedema coma can present insidiously, mimicking neurological emergencies like stroke.
  • Early recognition is crucial but challenging due to overlapping symptoms.

Conclusions:

  • Myxedema coma requires urgent recognition and management.
  • Key interventions include rapid intravenous thyroid hormone (T4) replacement (300-500 μg/24h, then 50-100 μg/day).
  • Supportive care and management of precipitating factors (e.g., infection) are essential.