Myxoedema coma. A review.

Abstract

Myxoedema coma is a rare emergency needing prompt recognition and urgent treatment before diagnostic confirmation. The pathyphysiology, clinical features, differential diagnosis, investigations and treatment are described. Triiodothyronine in small doses intravenously with continuous cardiac monitoring is suggested. Slow rewarming, care of the airway and prompt treatment of hypoventilation by assisted ventilation, the use of hydrocortisone and the avoidance of sedatives, vasopressors and overloading are also discussed, as is prevention. This emergency occurs in elderly people often with co-existent disease and thus only close attention to detail will be rewarded with improving results and falling mortality figures.