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Myxedema coma and normal serum thyroxine.

G Lizarralde, J G Baldwin, H G McCulley

    Southern Medical Journal
    |July 1, 1978
    PubMed
    Summary
    This summary is machine-generated.

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    This study details a patient with myxedema coma despite normal thyroxine levels, indicating potential issues with thyroid hormone conversion and pituitary function.

    Area of Science:

    • Endocrinology
    • Thyroid Disorders
    • Neuroendocrinology

    Background:

    • Myxedema coma is a severe manifestation of hypothyroidism.
    • Thyroid hormone replacement therapy typically involves levothyroxine (T4).
    • Assessing thyroid hormone levels (T4, T3) and TSH response to TRH is crucial for diagnosis.

    Observation:

    • A 76-year-old male presented with myxedema coma but had normal serum thyroxine (T4) levels.
    • Low serum triiodothyronine (T3) persisted despite T4 therapy, with T4 levels in the hyperthyroid range.
    • The patient showed no TSH release after TRH stimulation and had an enlarged sella turcica.

    Findings:

    • The patient exhibited a unique thyroid hormone profile: normal T4, low T3, and blunted TSH response.
    • An enlarged sella turcica suggests a potential pituitary or hypothalamic abnormality.

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  • These findings point towards a complex endocrine dysfunction beyond simple hypothyroidism.

    • Implications:

    • This case suggests a possible partial defect in peripheral conversion of T4 to T3.
    • The pituitary and thyroid axes may be involved in this patient's condition.
    • Further research is needed to understand such atypical presentations of thyroid dysfunction.