Myxedema Coma: A rare presentation of hypothyroidism

Myxedema coma is an extreme manifestation of hypothyroidism presenting with altered level of consciousness, hypothermia, bradycardia, hypotension, hypoglycemia, and hypoventilation. It is an endocrine emergency. Now it has become a rare presentation due to early detection and treatment of hypothyroidism. The common precipitating factors like sepsis, myocardial infarction, hypothermia, sedative medications, and surgery should be addressed in a poorly controlled hypothyroid patient as early as possible. Treatment with high dose thyroid hormones and steroids should be started on clinical suspicion even before the laboratory confirmation. We present a case of an 85-year-old woman who presented to the emergency room with one day history of reduced level of consciousness, found to have bradycardia and hypothermia. Her symptoms significantly improved with oral levothyroxine therapy.