Abstract Introduction Myxedema coma is a rare, life-threatening disease. Patients present with vague symptoms and severe cases have multiorgan dysfunction. We present a case of severe hypoxic respiratory failure due to myxedema coma treated with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) as a bridge to recovery. Case Presentation A 38-year-old male with no past medical history presented with a 2-year history of slowly progressive dyspnea and 4-week history of significantly increased dyspnea. Patient reported orthopnea, lethargy, lower extremity edema, cold intolerance, and constipation. He was intubated at outside facility and transferred for advanced therapies. Upon arrival, patient was unable to be oxygenated despite maximal ventilator support with a PaO2/FiO2 ratio of 48. Patient remained hemodynamically stable without vasopressor requirements and was cannulated for VV ECMO. Transthoracic echocardiogram showed ejection fraction 55-60%, mild right ventricle dilation with mildly reduced systolic function, and large pericardial effusion without tamponade physiology. CT chest showed diffuse consolidations as shown in the image. Patient had findings of periorbital edema, pretibial edema, hypothermia, and bradycardia. Laboratory findings included thyroid stimulating hormone 150 uIU/mL, total triiodothyronine 0.1 ng/mL, total thyroxine 0.7 uIU/mL, and free thyroxine 0.4 ng/dL. The patient was treated with intravenous levothyroxine bolus followed by intravenous levothyroxine for 3 days, stress dose steroids, and diuresis. He was diuresed 39 liters net negative, weaned off VV ECMO, and subsequently extubated. He was transitioned to PO levothyroxine, discharged home on 4L NC, and follow up CT chest showed complete resolution of the consolidations. Discussion Incidence rates of myxedema coma range from 0.22-1.09 per million people per year and mortality ranges from 20-30%. It presents with altered mental status and symptoms of hypothyroidism. Severe cases have multiorgan dysfunction including cardiac and respiratory failure requiring intubation and vasopressors. There are cases of circulatory support used for myxedema coma. However, those cases used veno-arterial (VA) ECMO for cardiogenic shock resulting in mortality or bridge to heart transplant. This case demonstrates that VV ECMO may be used as bridge to recovery for respiratory support alone in the absence of cardiogenic shock for myxedema coma. Conclusion Myxedema coma is a rare life-threatening disorder that can cause respiratory and cardiac failure. There have been successful cases using VA ECMO for cardiogenic shock as bridge to heart transplant. We present a case of successful use of VV ECMO as bridge to recovery for respiratory support in the setting of myxedema coma without cardiogenic shock. This abstract is funded by: None
Gaskey et al. (Fri,) studied this question.
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