Myxedema Coma

  • Leonard WartofskyEmail author
  • Joanna Klubo-Gwiezdzinska


Myxedema coma is the most severe form of hypothyroidism and carries a high mortality risk. Patients are typically elderly women who present in winter with deteriorating mental status, hypothermia, bradycardia, and multisystem organ failure. Aggressive therapy is required to avoid a fatal outcome.


Coma Hypothyroidism Thyroxine Triiodothyronine Hypoglycemia Hypothermia Hyponatremia Hypoxemia Bradycardia Hypercarbia 


  1. 1.
    Ord WM. Report of a committee of the Clinical Society of London to investigate the subject of myxedema. Trans Clin Soc (Lond). 1888;21:1–215.Google Scholar
  2. 2.
    LeMarquand HS, Hausmann W, Hemstead EH. Myxedema as a cause of death. BMJ. 1953;1:704–6.CrossRefGoogle Scholar
  3. 3.
    Summers VK. Myxedema coma. BMJ. 1953;2:336–8.CrossRefGoogle Scholar
  4. 4.
    Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med. 2007;22:224–31.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Rodriguez I, Fluiters E, Perez-Mendez LF, et al. Factors associated with mortality of patients with myxedema coma: prospective study in 11 cases treated in a single institution. J Endocrinol. 2004;80:347–50.CrossRefGoogle Scholar
  6. 6.
    Blignault EJ. Advanced pregnancy in severely myxedematous patient. A case report and review of the literature. S Afr Med J. 1980;57:1050–1.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Patel S, Robinson S, Bidgood RJ, et al. A pre-eclamptic-like syndrome associated with hypothyroidism during pregnancy. Q J Med. 1991;79:435–41.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Mathew V, Misgar RA, Ghosh S, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011;2011:493462.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Church CO, Callen EC. Myxedema coma associated with combination aripiprazole and sertraline therapy. Ann Pharmacother. 2009;43:2113–6.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Chu M, Seltzer TF. Myxedema coma induced by ingestion of raw bok choy. N Engl J Med. 2010;362(20):1945–6.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Klubo-Gwiezdzinska J, Wartofsky L. Myxedema coma. In: Wass JAH, Stewart PM, Amiel SA, Davies MJ, editors. Oxford textbook of endocrinology and diabetes. 2nd ed. Oxford: Oxford Univ. Press; 2011;343:537–543.Google Scholar
  12. 12.
    Reinhardt W, Mann K. Incidence, clinical picture and treatment of hypothyroid coma. Results of a survey. Med Klin. 1997;92:521–4.CrossRefGoogle Scholar
  13. 13.
    Jansen HJ, Doebe SR, Louwerse ES, et al. Status epilepticus caused by a myxedema coma. Neth J Med. 2006;64:202–5.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Zwillich CW, Pierson DJ, Hofeldt FD, et al. Ventilatory control in myxedema and hypothyroidism. N Engl J Med. 1975;292:662–5.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Ladenson PW, Goldenheim PD, Ridgway EC. Prediction of reversal of blunted respiratory responsiveness in patients with hypothyroidism. Am J Med. 1988;84:877–83.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Birring SS, Patel RB, Parker D, et al. Airway function and markers of airway inflammation in patients with treated hypothyroidism. Thorax. 2005;60:249–53.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Schenck JB, Rizvi AA, Lin T. Severe primary hypothyroidism manifesting with torsades de pointes. Am J Med Sci. 2006;331:154–6.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Urquhart AD, Rea IM, Lawson LT, et al. A new complication of hypothyroid coma: neurogenic dysphagia: presentation, diagnosis, and treatment. Thyroid. 2001;11:595–8.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Chadha JS, Ashby DW, Cowan WK. Fatal intestinal atony in myxoedema. Brit Med J. 1969;3:398.CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Ji JS, Chae HS, Cho YS, et al. Myxedema ascites: case report and literature review. J Korean Med Sci. 2006;21(4):761.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Fukunaga K. Refractory gastrointestinal bleeding treated with thyroid hormone replacement. J Clin Gastroenterol. 2001;33:145–7.CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Bergeron E, Mitchell A, Heyen F, et al. Acute colonic surgery and unrecognized hypothyroidism: a warning. Report of six cases. Dis Colon Rectum. 1997;40:859–61.CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Skowsky RW, Kikuchi TA. The role of vasopressin in the impaired water excretion of myxedema. Am J Med. 1978;64:613–21.CrossRefPubMedCentralGoogle Scholar
  24. 24.
    FR DR Jr, Michelis MF, Bloom ME, et al. Impaired water excretion in myxedema. Am J Med. 1971;51:41–53.CrossRefGoogle Scholar
  25. 25.
    Ardalan MR, Ghabili K, Mirnour R, et al. Hypothyroidism-induced rhabdomyolysis and renal failure. Ren Fail. 2011;33:553–4.CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Nikolaidou C, Gouridou E, Ilonidis G, et al. Acute renal dysfunction in a patient presenting with rhabdomyolysis due to Hypothyroidism attributed to Hashimoto’s disease. Hippokratia. 2010;4:281–3.Google Scholar
  27. 27.
    Birewar S, Oppenheimer M, Zawada ET Jr. Hypothyroid acute renal failure. SDJ Med. 2004;57:109–10.Google Scholar
  28. 28.
    Kar PM, Hirani A, Allen MJ. Acute renal failure in a hypothyroid patient with rhabdomyolysis. Clin Nephrol. 2003;60:428–9.CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Manfredi E, van Zaane B, Gerdes VE, et al. A hypothyroidism and acquired von Willebrand’s syndrome: a systematic review. Haemophilia. 2008;14:423–33.CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Michiels JJ, Schroyens W, Berneman Z, et al. Acquired von Willebrand syndrome type 1 in hypothyroidism: reversal after treatment with thyroxine. Clin Appl Thromb Hemost. 2001;7:113–5.CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Dutta P, Bhansali A, Masoodi SR, et al. Predictors of outcome in myxedema coma: a study from a tertiary care centre. Crit Care. 2008;12(R1):1–8.CrossRefGoogle Scholar
  32. 32.
    Yamamoto T, Fukuyama J, Fujiyoshi A. Factors associated with mortality of myxedema coma: report of eight cases and literature survey. Thyroid. 1999;9:1167–74.CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Sanders V. Neurologic manifestations of myxedema. N Engl J Med. 1962;266:547–51.CrossRefGoogle Scholar
  34. 34.
    Hooper MJ. Diminished TSH secretion during acute non-thyroidal illness in untreated primary hypothyroidism. Lancet. 1976:48–9.CrossRefGoogle Scholar
  35. 35.
    Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the ‘euthyroid sick syndrome’. Endocr Rev. 1982;3:164–217.CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, Wartofsky L. A diagnostic scoring system for patients with myxedema coma. Endocr Pract. 2014;8:808–17.CrossRefGoogle Scholar
  37. 37.
    Nicoloff JT. Thyroid storm and myxedema coma. Med Clin North Am. 1985;69:1005–17.CrossRefPubMedCentralGoogle Scholar
  38. 38.
    Vachharajani TJ, Zaman F, Abreo KD. Hyponatremia in critically ill patients. J Intensive Care Med. 2003;18:3–8.CrossRefPubMedCentralGoogle Scholar
  39. 39.
    Pereira VG, Haron ES, Lima-Neto N, et al. Management of myxedema coma: report on three successfully treated cases with nasogastric or intravenous administration of triiodothyronine. J Endocrinol Investig. 1982;5:331–4.CrossRefGoogle Scholar
  40. 40.
    Verbalis JG, Goldsmith SR, Greenberg A, et al. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007;120:1–21.CrossRefGoogle Scholar
  41. 41.
    Vaprisol (conivaptan HCl injection). Package insert. Deerfield, IL, Astellas Tokai Co; 2006.Google Scholar
  42. 42.
    Hline SS, Pham PT, Pham PT, et al. Conivaptan: a step forward in the treatment of hyponatremia. Ther Clin Risk Manag. 2008;4:315–26.CrossRefPubMedCentralGoogle Scholar
  43. 43.
    Li-Ng M, Verbalis JG. Conivaptan: evidence supporting its therapeutic use in hyponatremia. Core Evid. 2010;4:83–92.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Kamilaris TC, DeBold CR, Pavlou SN, et al. Effect of altered thyroid hormone levels on hypothalamic-pituitary-adrenal function. J Clin Endocrinol Metab. 1987;65:994–9.CrossRefGoogle Scholar
  45. 45.
    Bigos ST, Ridgway EC, Kourides IA, et al. Spectrum of pituitary alterations with mild and severe thyroid impairment. J Clin Endocrinol Metab. 1978;46:317–25.CrossRefPubMedCentralGoogle Scholar
  46. 46.
    Holvey DN, Goodner CJ, Nicoloff JT, et al. Treatment of myxedema coma with intravenous thyroxine. Arch Intern Med. 1964;113:139–46.CrossRefGoogle Scholar
  47. 47.
    Rodriguez I, Fluiters E, Perez-Mendez LF, et al. Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution. J Endocrinol. 2004;180:347–50.CrossRefPubMedCentralGoogle Scholar
  48. 48.
    Hylander B, Rosenqvist U. Treatment of myxedema coma: factors associated with fatal outcome. Acta Endocrinol. 1985;108:65–71.CrossRefPubMedCentralGoogle Scholar
  49. 49.
    Blackburn CM, McConahey WM, Keating RF. Calorigenic effects of single intravenous doses of L-triiodothyronine and L-thyroxine in myxedematous persons. J Clin Invest. 1954;33:819–24.CrossRefPubMedCentralGoogle Scholar
  50. 50.
    Chernow B, Burman KD, Johnson DL, et al. T3 may be a better agent than T4 in the critically ill hypothyroid patient: evaluation of transport across the blood-brain barrier in a primate model. Crit Care Med. 1983;11:99–104.CrossRefPubMedCentralGoogle Scholar
  51. 51.
    McKerrow SD, Osborn LA, Levy H, et al. Myxedema-associated cardiogenic shock treated with triiodothyronine. Ann Intern Med. 1992;117:1014–5.CrossRefGoogle Scholar
  52. 52.
    Wartofsky L. Myxedema coma. Endocrinol Metab Clin N Am. 2006;35:687–98.CrossRefGoogle Scholar
  53. 53.
    McCulloch W, Price P, Hinds CJ, et al. Effects of low dose oral triiodothyronine in myxedema coma. Intensive Care Med. 1985;11:259–62.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Leonard Wartofsky
    • 1
    • 2
    Email author
  • Joanna Klubo-Gwiezdzinska
    • 1
    • 3
  1. 1.Georgetown University School of MedicineWashington, DCUSA
  2. 2.Thyroid Cancer Research UnitMedStar Health Research InstituteWashington, DCUSA
  3. 3.National Institutes of Health—National Institute of Diabetes and Digestive and Kidney DiseaseBethesdaUSA

Personalised recommendations