J Korean Soc Endocrinol.  2004 Apr;19(2):203-208.

A Case of Myxedema Coma with Severe Hypoventilation

• Shim JY
• Lee SW
• Lee HW
• Choi JH
• Song YJ
• Lee HS
• Chung YS
• Lee KW

Abstract

A myxedema coma, representing the extreme feature of hypothyroidism is rare. Despite early vigorous treatment, a myxedema coma is associated with a mortality rate as high as 60%. Herein, a case of a myxedema coma, with severe hypoventilation, is described. When the patient arrived at the emergency room, she complained of dyspnea and general weakness, and was of a drowsy mental status. 7 days after admission, she was more confused and disoriented, and respiratory insufficiency had developed. Although levothyroxine was continued and her respiration improved, she still had a confused mentality and seizure developed. Despite medication her consciousness did not improve, so was discharged in despair by her family members. The respiratory abnormality with a myxedema coma is a depressed ventilatory response to hypercapnea, resulting in a decrease in alveolar ventilation, with progressive CO2 retention. An upper airway obstruction, especially during sleep, and neuromuscular dysfunction in breathing may be shown in hypothyroidism. Therefore, a myxedema coma, accompanied by severe hypoventilation, should be intensively treated with thyroid hormone replacement therapy and mechanical ventilatory support

MeSH Terms

Airway Obstruction
Coma*
Consciousness
Dyspnea
Emergency Service, Hospital
Hormone Replacement Therapy
Humans
Hypothyroidism
Hypoventilation*
Mortality
Myxedema*
Respiration
Respiratory Insufficiency
Seizures
Thyroid Gland
Thyroxine
Ventilation
Thyroxine