A 62-year-old man on ICU develops myxoedema coma. TSH 85, free T4 is 2 pmol/L. He is hypothermic, bradycardic, hypotensive, and comatose. What is the ...

Question

A 62-year-old man on ICU develops myxoedema coma. TSH 85, free T4 is 2 pmol/L. He is hypothermic, bradycardic, hypotensive, and comatose. What is the immediate treatment?

Accepted Answer

IV levothyroxine loading dose plus IV liothyronine for faster onset, PLUS IV hydrocortisone (must be given before or with thyroid hormone to prevent precipitating adrenal crisis) - passive rewarming only (active external rewarming risks cardiovascular collapse)

Answer

Oral levothyroxine 25 mcg daily

Answer

Oral liothyronine only

Answer

Active rewarming to 37 degrees immediately

Answer

Supportive care only

uk-fficm MCQ (SBA): Myxoedema Coma

A 62-year-old man on ICU develops myxoedema coma. TSH 85, free T4 is 2 pmol/L. He is hypothermic, bradycardic, hypotensive, and comatose. What is the immediate treatment?