Board Review: Myxedema Coma 

Which of the following medications is most appropriate for the treatment of myxedema coma in the emergency department?  (scroll down for the answer) 

A) PO Levothyroxine

B) IV Thyroxine 

C) IV Propranolol 

D) IV Potassium Iodide 

The correct answer is B) IV Thyroxine. 

IV thyroxine or IV triiodothyronine is used to replace thyroid hormone in patients with myxedema coma. 

Steps of Myxedema Coma Treatment 

1) Stabilization

   - special focus on passive rewarming for hypothermia and dextrose for hypoglycemia

2) Thyroid Replacement

   - IV thyroxine or IV triiodothyronine 

   - IV thyroxine preferred in elderly and those with cardiac disease

3) Identify Precipitating Factors

   - could include: infection, trauma, cardiac or cerebral ischemia, anesthetic agent, hypoxia, GI bleed, cold exposure, etc. 

Stapczynski, J. Stephan,, and Judith E. Tintinalli. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011.