From the Popoveniuc Score to Therapeutic Protocols: A Comprehensive Review of Myxedema Coma

Myxedema coma represents the most severe and life-threatening manifestation of hypothyroidism, characterized by multiorgan dysfunction, which leads to high mortality. Its incidence is low, estimated at less than one case per million inhabitants, but it constitutes an endocrinological emergency of great clinical relevance. The pathophysiology is related to the loss of compensatory mechanisms in response to precipitating factors, triggering neurological, cardiovascular, respiratory, and metabolic alterations. Diagnosis is often delayed due to the nonspecific nature of initial symptoms and the fact that serum thyroid hormone concentrations do not accurately reflect the severity of the condition. In this context, clinical tools such as the Popoveniuc scale have become valuable in supporting diagnostic suspicion. Early recognition and timely initiation of treatment with hormone replacement therapy and intensive supportive care are essential to improve prognosis and reduce complications, underscoring the importance of increased clinical awareness in emergency and critical care settings.