A 55-year-old man on ICU develops acute myxoedema coma. He presents with hypothermia (core temperature 32.5°C), bradycardia (HR 40 bpm), hypotension (...

Question

A 55-year-old man on ICU develops acute myxoedema coma. He presents with hypothermia (core temperature 32.5°C), bradycardia (HR 40 bpm), hypotension (BP 80/50), GCS 6, and hyponatraemia (sodium 118 mmol/L). TSH is >100 mU/L, free T4

Accepted Answer

IV levothyroxine (T4) loading dose 300-500 mcg, IV hydrocortisone 100 mg stat, supportive care with warming and haemodynamic support

Answer

Oral levothyroxine 25 mcg daily

Answer

IV liothyronine (T3) alone

Answer

External warming to 38°C rapidly

Answer

IV hypertonic saline for the hyponatraemia as the sole treatment

uk-fficm MCQ (SBA): Myxoedema Coma

A 55-year-old man on ICU develops acute myxoedema coma. He presents with hypothermia (core temperature 32.5°C), bradycardia (HR 40 bpm), hypotension (BP 80/50), GCS 6, and hyponatraemia (sodium 118 mmol/L). TSH is >100 mU/L, free T4 <3 pmol/L. What is the immediate treatment?