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[Myxedema coma as a rare postoperative complication]

M Ragaller1, M Quintel, H J Bender

  • 1Institut für Anästhesiologie und operative Intensivmedizin, Fakultät für klinische Medizin Mannheim, Universität Heidelberg.

Der Anaesthesist
|March 1, 1993
PubMed
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Myxedema coma, a severe complication of hypothyroidism, can occur post-surgery. Intravenous L-thyroxine is crucial for treating unconscious patients when oral therapy fails, leading to full recovery.

Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Nephrology

Background:

  • Myxedema coma, a severe manifestation of hypothyroidism, carries a high mortality rate (50-80%).
  • It can be precipitated by surgery, anesthesia, or infection in patients with subclinical hypothyroidism.
  • This case highlights a rare postoperative complication.

Observation:

  • A 46-year-old woman developed cardiac arrest post-hip replacement surgery.
  • She experienced pneumonia, ARDS, and acute renal failure, remaining in a deep coma.
  • Diagnosed with myxedema coma based on low thyroid hormones (T3, T4) and elevated TSH.

Findings:

  • Initial oral L-thyroxine therapy was ineffective.
  • Intravenous L-thyroxine administration resulted in consciousness recovery within 36 hours.

Related Experiment Videos

  • The patient recovered fully with normal neuropsychological and cardiopulmonary function.

    • Implications:

    • Postoperative unexplained unconsciousness warrants exclusion of thyroid failure.
    • Intravenous L-thyroxine is a critical treatment for myxedema coma, especially when oral routes fail.
    • Extended monitoring is essential during intravenous L-thyroxine therapy due to cardiac risks.