Abstract Introduction Myxedema coma is a rare but life-threatening endocrine emergency caused by long-standing untreated severe hypothyroidism. It is characterized by altered mental status, hypothermia, bradycardia, and hypotension. Mortality has been reported between 20% and 50%. Early recognition and rapid thyroid hormone replacement, along with supportive management, are crucial for improving survival. Standard treatment includes high-dose intravenous levothyroxine and stress-dose glucocorticoids due to the risk of concomitant adrenal insufficiency. Clinical Case A 32-year-old male presented to the emergency department with complaints of vomiting, numbness in the hands and feet, and chest pain. He had a history of Hashimoto’s thyroiditis and had discontinued his daily 100 µg levothyroxine treatment in recent months. On admission, his body temperature was 36.3 °C, blood pressure 88/53 mmHg, and heart rate 43 bpm. Electrocardiography revealed sinus bradycardia. No obivous edema was detected on physical examination. Laboratory tests demonstrated TSH 433 µIU/mL, free T4 0.03 ng/mL, free T3 0.39 pg/mL, Sodium 140 mEq/L, creatinine 1.17 mg/dL, AST 285 U/L, ALT 190 U/L, creatine kinase 2466 U/L, and CRP 1.8 mg/L. Based on bradycardia, hypotension, and laboratory findings, myxedema coma was diagnosed. Intravenous levothyroxine and methylprednisolone treatment were started with fluid resuscitation. Chest X-ray demonstrated an enlarged cardiac silhouette, and echocardiography revealed a large pericardial effusion compressing the right ventricle. Pericardiocentesis was performed, yielding 300 cc of serous fluid. Resulting in normalization of blood pressure and heart rate. Follow-up laboratory evaluation demonstrated a progressive decline in TSH levels; accompanied by a concomitant rise in free T3 and free T4. Levothyroxine therapy was continued orally on the third day, and methylprednisolone was tapered from the fourth day. A follow-up chest X-ray confirmed regression of the pericardial effusion. Conclusion Although myxedema coma is most commonly seen in elderly women, this case demonstrates that it can also occur in young men. The hallmark diagnostic features are altered mental status, hypothermia, bradycardia, hypotension, and laboratory evidence of severe hypothyroidism. Pericardial effusion is a recognized complication of myxedema coma, usually asymptomatic, but in this patient, it contributed to hypotension and impaired cardiac function. Prompt pericardiocentesis led to dramatic clinical improvement. This case highlights the importance of early recognition, appropriate management, and careful monitoring of complications in myxedema coma, emphasizing that it can occur at any age and in both genders.Figure 1:Chest X-rayAn enlarged cardiac silhouette
YORULMAZ et al. (Thu,) studied this question.