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Supraglottic myxoedema successfully treated orally.

Yu Arai1, Satoru Okada1, Taiju Miyagami2

  • 1Department of Family & General Medicine, Tokyo-Kita Medical Center, Japan.

Endocrinology, Diabetes & Metabolism Case Reports
|February 20, 2024
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Myxoedema coma, a severe hypothyroidism complication, can cause life-threatening supraglottic oedema. This case highlights successful treatment with oral thyroid hormone, even with severe laryngeal oedema and respiratory failure.

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Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Otolaryngology

Background:

  • Myxoedema coma is a severe manifestation of hypothyroidism, presenting with multi-organ dysfunction, altered consciousness, and hypothermia.
  • Supraglottic myxoedema, a rare but potentially fatal complication, can cause significant upper airway obstruction.

Purpose of the Study:

  • To report a case of myxoedema coma with severe supraglottic oedema successfully treated with oral thyroid hormone.
  • To emphasize the importance of considering supraglottic oedema in myxoedema coma, even without typical upper airway obstruction signs.

Main Methods:

  • A 66-year-old male with impaired consciousness and hypothermia was diagnosed with hypothyroidism and myxoedema coma.
  • Initial management included intubation for respiratory failure, complicated by severe laryngeal oedema, followed by oral thyroid hormone therapy and tracheostomy.
  • The patient's respiratory status and laryngeal oedema improved, leading to ventilator weaning and eventual tracheostomy removal.

Main Results:

  • The patient successfully recovered from myxoedema coma and supraglottic oedema with oral thyroid hormone therapy.
  • Tracheostomy was necessary due to prolonged respiratory failure and laryngeal oedema, but was later removed.
  • The patient was discharged and remained stable for three months post-treatment.

Conclusions:

  • Myxoedema coma with supraglottic oedema can be effectively managed with oral thyroid hormone replacement.
  • Supraglottic oedema should be suspected in patients with myxoedema coma presenting with respiratory compromise, irrespective of wheezing.
  • Early recognition and intervention are critical for improving outcomes in myxoedema coma and its airway complications.