J Korean Med Sci.  2010 Sep;25(9):1394-1397. 10.3346/jkms.2010.25.9.1394.

A Case of Myxedema Coma Presenting as a Brain Stem Infarct in a 74-Year-Old Korean Woman

• Ahn JY
• Kwon HS
• Ahn HC
• Sohn YD

• KMID: 1785926
• DOI: http://doi.org/10.3346/jkms.2010.25.9.1394

Abstract

Myxedema coma is the extreme form of untreated hypothyroidism. In reality, few patients present comatose with severe myxedema. We describe a patient with myxedema coma which was initially misdiagnosed as a brain stem infarct. She presented to the hospital with alteration of the mental status, generalized edema, hypothermia, hypoventilation, and hypotension. Initially her brain stem reflexes were absent. After respiratory and circulatory support, her neurologic status was not improved soon. The diagnosis of myxedema coma was often missed or delayed due to various clinical findings and concomitant medical condition and precipitating factors. It is more difficult to diagnose when a patient has no medical history of hypothyroidism. A high index of clinical suspicion can make a timely diagnosis and initiate appropriate treatment. We report this case to alert clinicians considering diagnosis of myxedema coma in patients with severe decompensated metabolic state including mental change.

Keyword

Myxedema Coma; Hypothyroidism; Stroke

MeSH Terms

Aged
Brain Stem Infarctions/diagnosis/radiography
Diagnosis, Differential
Diagnostic Errors
Echocardiography
Female
Humans
Hypothyroidism/complications/drug therapy
Myxedema/*diagnosis/etiology/radiography
Republic of Korea
Thyroxine/therapeutic use
Tomography, X-Ray Computed

Figure

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  Fig. 1 The gross photos of patient's face and extremities. (A, B) Severe periorbital edema and thinned eyebrow. (C, D) Non-pitting edema and desquamation of the hands and feet.

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  Fig. 2 Initial ECG showed sinus bradycardia (ventricular rate 59/min), low QRS voltage, and a prolonged QT interval (QTc >470 ms).

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  Fig. 3 Chest X-rays. (A) Initial chest X-ray revealed cardiomegaly and infiltration of the left lower lung zone. (B) Follow-up X-ray showed an improved state.

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  Fig. 4 Echocardiography. Parasternal long axis view (A) and apical four chamber view (B) revealed a moderate amount of pericardial effusion without hemodynamic significance; effusion was localized to the right atrium.

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