Myxoedema coma in a patient with alcohol dependence: a diagnostic pitfall.
Jomcy John, Andrew Campbell
✦ AI-curated · Sources linked
Case in brief
A man in his sixties with known hypothyroidism and alcohol dependence presented with profound hypothermia, refractory hypoglycaemia, hypoxia, and reduced consciousness. Initial assessments suggested alcohol intoxication, but further examination revealed periorbital oedema and moderate pericardial effusion. Thyroid function tests confirmed severe hypothyroidism. The patient was treated with intravenous glucose, hydrocortisone, and thyroxine, leading to significant clinical improvement.
What made this case unusual
The case illustrates the diagnostic challenge of myxoedema coma, particularly in patients with confounding factors like alcohol dependence, which can obscure the underlying endocrine emergency.
Diagnostic / clinical pearl
Clinicians should maintain a high index of suspicion for myxoedema coma in patients with hypothyroidism, especially when presenting with altered mental status and hypothermia.
Why it matters
Recognizing myxoedema coma early can significantly impact patient outcomes, particularly in cases complicated by other conditions such as alcohol dependence.