Hypothyroid Crisis: Oral or Intravenous Treatment? A Report of Two Cases

Hypothyroid crisis, or myxoedema coma, is a rare condition with high mortality and must be treated promptly. Even though it may be unfavourable, most guidelines only focus on intravenous drug administration due to lack of data on oral treatment.

The course of oral treatment in two patients admitted in our hospital is described. Patients were treated with levothyroxine 1.3 μg/kg and liothyronine 25 μg twice daily, followed after 1 week with only levothyroxine 1.3 μg/kg daily. Oral treatment was successful in both patients without complications or side-effects.

Oral substitution is an appropriate alternative to intravenous substitution, which has potential disadvantages and is associated with higher mortality.

Hypothyroid crisis or myxoedema coma is a rare condition with a high mortality rate, so early diagnosis and prompt treatment are necessary.High-dose intravenous treatment is associated with higher mortality, so oral substitution may be an acceptable approach, especially as intravenous medicines are not widely available.