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Myxedema Coma Case Study

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Introduction Myxedema coma, a rare presentation of hypothyroidism, is defined as severe hypothyroidism presenting with decreased mental status, hypothermia, as well as multiple organ dysfunction. It is a medical emergency, associated with a high mortality rate. We report the case of myxedema coma presenting as altered mental status in the setting of acute renal failure. Case Presentation An 83 year old male with past medical history of coronary artery disease, hypertension, hypothyroidism, stage four bladder cancer and bilateral hydronephrosis with recent bilateral stent placement was brought to the emergency department at an outlying hospital by his son due to increased lethargy and confusion. He was found to have acute renal failure, and…show more content…
His initial blood pressure was 113/60 mmHg, her heart rate was 50 beats/min, and his oxygen saturation was 100%. His Glasgow Coma Scale was 8. His physical exam was also remarkable for dry mucous membranes, and distant heart sounds, in addition to weak lower extremity pulses and non-pitting edema. No thyroid goiter was palpable. Laboratory investigations on admission showed a hemoglobin of 10.2, impaired renal function with creatinine of 7.3mg/dl and potassium of 7.1mmol/L. Nephrology service was contacted and hemodialysis was initiated. Mental status did not improve following dialysis, therefore a computed tomography scan (CT) of the head and a Thyroid stimulating hormone level (TSH) were ordered to rule out other causes of altered mental status. His CT scan did not show any acute findings. His TSH level was 51.4UIU/ML and his free T 4 level was 0.1NG/DL. The patient was immediately started on intravenous levothyroxine sodium hydrate (100 μg/day) and intravenous dexamethasone (4mg), in addition to supportive measures. His mental condition improved dramatically within a few days along, and his free t4 normalized. His kidney function improved after requiring one session of
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