Distributive and Refractory Shock in Myxoedema Coma

Myxoedema coma is a rare medical emergency, presenting even less commonly without sepsis and with the diagnosis of distributive shock. Reports of catecholamine-refractory shock are scarce. This report describes the case of a 54-year-old male, who presented to the emergency department with altered mental status. He was found to be hypothermic, hypotensive, and bradycardic, with poor peripheral perfusion and oedema of the face and hands. On initial evaluation, the patient was found to have acute renal failure, hyponatraemia, hyperkalaemia, and findings suggestive of metabolic acidosis. Clinical examination confirmed a suspected diagnosis of distributive shock with multiorgan dysfunction, refractory to volume, and vasopressor support. The patient was admitted to the intensive care unit for treatment and organ support. Further diagnostic studies revealed an elevated thyroid-stimulating hormone level and decreased T3 and T4, favouring the diagnosis of myxoedema coma. Hydrocortisone and levothyroxine were initiated intravenously for the treatment of suspected myxoedema coma, resulting in rapid clinical improvement.