Myxedema coma complicated by bilateral hygromas

Area of Science:

• Endocrinology
• Critical Care Medicine
• Neurology

Background:

• Myxedema coma is a life-threatening endocrine emergency often presenting diagnostic challenges due to a lack of specific criteria.
• Untreated hypothyroidism can progress to myxedema coma, requiring prompt recognition and intervention.
• Gastrointestinal symptoms, hypothermia, bradycardia, and central nervous system (CNS) involvement are key features.

Purpose of the Study:

• To report a unique case of myxedema coma associated with bilateral hygromas.
• To emphasize the diagnostic difficulties and importance of early treatment for myxedema coma.
• To highlight a potential, previously unreported association between severe hypothyroidism and hygroma formation.

Main Methods:

• Case report detailing a patient with a history of untreated hypothyroidism.
• Clinical presentation including recurrent severe constipation, urinary tract infection, and subsequent myxedema coma.
• Neuroimaging utilized to identify bilateral hygromas, with assessment of treatment response.

Main Results:

• The patient developed myxedema coma precipitated by a urinary tract infection.
• Complications included recurrent seizures and the novel finding of bilateral hygromas on neuroimaging.
• Hormone replacement therapy led to complete clinical recovery and regression of hygromas.

Conclusions:

• Myxedema coma requires a high index of suspicion in critically ill patients, especially those with hypothyroidism.
• Neuroimaging is a valuable diagnostic tool in suspected myxedema coma cases.
• This case suggests a possible association between severe hypothyroidism and hygroma, warranting further investigation.