Myxedema coma associated with Covid-19 infection: case report

Abstract

The coronavirus disease 2019 pandemic continues to exert a significant impact on global health care systems, causing devastating mortality and morbidity. As time passes and our understanding of this novel respiratory virus deepens, it is increasingly clear that its effects extend beyond that of the respiratory system. The link with endocrine disorders was noticed quite early when it was found that patients with diabetes and uncontrolled hyperglycemia were at an increased risk of severe disease as well as mortality from COVID-19. However, the other endocrine manifestations of COVID-19 probably were more subtle and information about them emerged more gradually over a period of time. Thyroid diseases are common endocrine disorders, and accordingly, a lot of attention has gone into the study of how COVID-19 affects the thyroid. Although the majority of mild to moderate COVID-19 patients remain euthyroid, a significant proportion of those with severe disease manifest with abnormalities in thyroid function. These manifestations include low thyroid stimulating hormone and low T3 levels, whereas low T4 levels were observed less commonly. Apart from this, several reports of subacute thyroiditis following COVID-19 have also been published. Similarly, Graves’ disease has been reported to occur in patients who had recovered from COVID-19. We present a case of a 55-year-old woman who presented to the emergency department and her physical examinations and laboratory results were significant for myxedema coma and the patient was given levothyroxine with improvement of symptoms and mild change in thyroid hormone levels during hospitalization.