Myxoedema Coma
Description General Measures Medicine Treatment ICD-10 code: E03.5/E03.9 Description Myxoedema coma is an uncommon condition characterized by severe hypothyroidism which may present with an altered mental status, lethargy, hypothermia, decreased organ function, and other non-specific features associated with hypothyroidism. Myxoedema coma is a life-threatening condition with a high mortalit
ICD-10 code: E03.5/E03.9
Description
Myxoedema coma is an uncommon condition characterized by severe hypothyroidism which may present with an altered mental status, lethargy, hypothermia, decreased organ function, and other non-specific features associated with hypothyroidism. Myxoedema coma is a life-threatening condition with a high mortality rate of up to 30%; rapid recognition is critical to avoid end-organ damage. Despite the name, coma is an uncommon presentation and is not necessary to make the diagnosis, however, its presence is a poor prognostic indicator.
General Measures
- Treat precipitant factor.
- Provide organ support, as needed.
- Use passive rewarming measures.
- Manage hypoglycaemia and hyponatraemia.
- Be cautious of upper airway compromise due to macroglossia and/or supraglottic myxoedema.
Medicine Treatment
- Hydrocortisone, IV, 100 mg 8 hourly.
Thyroid hormone replacement
- Levothyroxine (T4), oral.
- Loading dose: 200 mcg as a single dose.
- Maintenance dose: 100 mcg, daily.
- Medication can be administered via NG tube if an IV formulation is unavailable.
Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 23: Adult Critical Care_NEMLC Medicine Recommendations Review Cycle_ 2020_2023