Advanced Practice: Pitfalls in Myxedema Coma
1. Not thinking of the diagnosis; this should be on your differential diagnosis for:
a. Bradycardia
b. Hypothermia
c. Altered mental status
d. Undifferentiated hypotension not responding to fluids or pressors or getting worse with pressors
2. Not considering underlying triggers of myxedema coma.
3. Assuming hypothermia is from environmental exposure → Myxedema coma most commonly occurs in the winter.
4. Waiting for labs before starting treatment
a. This is a clinical diagnosis and mortality rises with delays in management.
b. Giving IV Thyroxine won’t harm the euthyroid patient if you’re wrong.
c. TSH/T4 may not accurately reflect disease process early on and with underlying critical illness.
5. Not treating with antibiotics
a. This clinically looks like sepsis.
b. Infection/sepsis is the most common inciting event of myxedema coma.
6. Aggressive warming → Leads to vasodilation and worsen hypotension and lead to cardiovascular collapse → stick to a warm blanket only.
7. Beware of pressors → Myxedema coma patients can respond paradoxically to pressors and drop there blood pressure.
8. Using T3 → can lead to MI and arrhythmias
References
Dr. M. Chansky. “Endocrine Emergencies”. Cooper University Hospital Emergency Department Resident Lecture Series. Cooper University Hospital. February 2018.