Myxoedema Coma Precipitated by Diabetic Ketoacidosis and Septic Shock: a Case Report

Authors

  • Rizq Badawi Department of Emergency Medicine, King Fahd Medical City, Riyadh, Saudi Arabia
  • Ahmed Alsuliamani Department of Emergency Medicine, King Fahd Medical City, Riyadh, Saudi Arabia
  • Abdullah Alhejaili Department of Emergency Medicine, King Fahd Medical City, Riyadh, Saudi Arabia
  • Eyad Alnemer Emergency/Critical Care, Ministry of Health, Medina, Saudi Arabia.

DOI:

https://doi.org/10.52609/jmlph.v4i2.128

Keywords:

DKA, Hypothyroidism, Myxedema Coma, Septic Shock

Abstract

Myxoedema coma (or myxoedema crisis) is a severe and potentially fatal form of decompensated hypothyroidism with an underlying cause. A low index of suspicion and a search for triggering factors should be the first step in dealing with the condition at an early stage. Myxoedema coma should be suspected in patients who present with hypothermia, altered mental status, and coma, even if hypothyroidism has not previously been recognized. The symptoms of hypothyroidism decompensation may mistakenly be attributed to its precipitating factors, which may include sepsis, cardiac failure, myocardial infarction, cerebrovascular accident, anaesthetic, sedatives, antidepressant medications, or metabolic and electrolyte abnormalities. Here, we present a case of myxoedema coma with two major underlying precipitating causes: septic shock and diabetic ketoacidosis.

References

Wartofsky L. Myxedema coma. Endocrinol Metab Clin North Am. 2006 Dec;35(4):687-98, vii-viii. doi: 10.1016/j.ecl.2006.09.003. PMID: 17127141.

Chiong YV, Bammerlin E, Mariash CN. Development of an objective tool for the diagnosis of myxedema coma. Transl Res. 2015 Sep;166(3):233-43. doi: 10.1016/j.trsl.2015.01.003. Epub 2015 Jan 13. PMID: 25647622.

Reinhardt W, Mann K. Häufigkeit, klinisches Bild und Behandlung des hypothyreoten Komas. Ergebnis einer Umfrage [Incidence, clinical picture and treatment of hypothyroid coma. Results of a survey]. Med Klin (Munich). 1997 Sep 15;92(9):521-4. German. doi: 10.1007/BF03044925. PMID: 9411198.

Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, Mukhopadhyay S, Chowdhury S. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011;2011:493462. doi: 10.4061/2011/493462. Epub 2011 Sep 15. PMID: 21941682; PMCID: PMC3175396.

Amin MS, Pabani UK, Lohano S, Khan Z. Myxedema Coma Precipitated by Sepsis in a Patient With a Complex Mental Health History. Cureus. 2023 Aug 16;15(8):e43574. doi: 10.7759/cureus.43574. PMID: 37719600; PMCID: PMC10503452.

Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med. 2007 Jul-Aug;22(4):224-31. doi: 10.1177/0885066607301361. PMID: 17712058.

Elkattawy S, Dhanoa P, Kotys J, Fichadiya H, Eckman A. Myxedema Coma: Case Report and Literature Review. Cureus. 2021 May 27;13(5):e15277. doi: 10.7759/cureus.15277. PMID: 34194879; PMCID: PMC8235691.

Finsterer J, Stöllberger C, Grossegger C, Kroiss A. Hypothyroid myopathy with unusually high serum creatine kinase values. Horm Res. 1999;52(4):205-8. doi: 10.1159/000023462. PMID: 10725787.

Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. J Epidemiol. 2017 Mar;27(3):117-122. doi: 10.1016/j.je.2016.04.002. Epub 2017 Jan 5. PMID: 28142035; PMCID: PMC5350620.

Bourcier S, Coutrot M, Ferré A, Van Grunderbeeck N, Charpentier J, Hraiech S, Azoulay E, Nseir S, Aissaoui N, Messika J, Fillatre P, Persichini R, Carreira S, Lautrette A, Delmas C, Terzi N, Mégarbane B, Lascarrou JB, Razazi K, Repessé X, Pichereau C, Contou D, Frérou A, Barbier F, Ehrmann S, de Montmollin E, Sztrymf B, Morawiec E, Bigé N, Reuter D, Schnell D, Ellrodt O, Dellamonica J, Combes A, Schmidt M. Critically ill severe hypothyroidism: a retrospective multicenter cohort study. Ann Intensive Care. 2023 Mar 9;13(1):15. doi: 10.1186/s13613-023-01112-1. PMID: 36892784; PMCID: PMC9998819.

Chen L, Wang L, Wang Y, Hu H, Zhan Y, Zeng Z, Liu L. Global, Regional, and National Burden and Trends of Down Syndrome From 1990 to 2019. Front Genet. 2022 Jul 15;13:908482. doi: 10.3389/fgene.2022.908482. PMID: 35910218; PMCID: PMC9337874.

Bansal D, Nanda A, Gupta E, Croker M, Williams ML, Bacchus A, Simmons D, Erbland M. Myxedema coma in a patient with Down's syndrome. J Ark Med Soc. 2006 Nov;103(5):112-3. PMID: 17112110.

Amr NH. Thyroid Disorders in Subjects with Down Syndrome: An Update. Acta Biomed. 2018 Mar 27;89(1):132-139. doi: 10.23750/abm.v89i1.7120. PMID: 29633736; PMCID: PMC6357620.

Westphal SA. Unusual presentations of hypothyroidism. Am J Med Sci. 1997 Nov;314(5):333-7. doi: 10.1097/00000441-199711000-00011. PMID: 9365336.

Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the American thyroid association task force on thyroid hormone replacement. Thyroid. 2014 Dec;24(12):1670-751. doi: 10.1089/thy.2014.0028. PMID: 25266247; PMCID: PMC4267409.

Bigos ST, Ridgway EC, Kourides IA, Maloof F. Spectrum of pituitary alterations with mild and severe thyroid impairment. J Clin Endocrinol Metab. 1978 Feb;46(2):317-25. doi: 10.1210/jcem-46-2-317. PMID: 108289.

Downloads

Published

2024-03-27

How to Cite

Badawi, R., Alsuliamani, A., Alhejaili , A. ., & Alnemer, E. . . (2024). Myxoedema Coma Precipitated by Diabetic Ketoacidosis and Septic Shock: a Case Report. The Journal of Medicine, Law & Public Health, 4(2), 385–390. https://doi.org/10.52609/jmlph.v4i2.128

Issue

Section

Case Report

Most read articles by the same author(s)