Myx’d up coma: a case of myxedema coma in trauma and literature review

Myxedema coma is a life-threatening complication of hypothyroidism that can present with altered mentation, bradycardia, and hypotension. Diagnosis can be challenging in trauma where hemorrhagic shock, sepsis, or neurotrauma can present similarly. Non-environmental hypothermia may differentiate it from other endocrine or traumatic causes. We describe a patient with an indoor fall at a nursing facility who presented to the emergency department as a trauma code. Initial vitals revealed hypotension, bradycardia, and hypothermia. Treatment included levothyroxine, hydrocortisone, and supportive measures. Mentation returned to baseline, hemodynamics normalized, and hypothermia resolved. He was transitioned to an oral thyroid replacement regimen, and he was discharged back to his nursing facility. This report highlights the importance of considering myxedema coma in trauma patients presenting with non-environmental hypothermia and hemodynamic instability. Early recognition and thyroid hormone replacement are critical for patient survival.