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It typically presents with nonspecific symptoms such as confusion, hypothermia, and bradycardia, delaying recognition, especially in elderly patients with multiple comorbidities. A 77-year-old man presented with reduced consciousness after progressive lethargy and confusion, severe hypothyroidism, and mild infection. Treatment with intravenous hydrocortisone, levothyroxine, later liothyronine, antibiotics, and supportive care led to rapid neurological improvement within 48 hours and gradual normalization of thyroid function. The case highlights diagnostic overlap with comorbidities and the possibility of undiagnosed disease as an initial presentation.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/myxedema-coma-as-the-initial-presentation-of-undiagnosed-hypothyroidism-a-rare-but-reversible-emergency/454243/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/myxedema-coma-as-the-initial-presentation-of-undiagnosed-hypothyroidism-a-rare-but-reversible-emergency/454243.png","ImageObject",300,407,{"name":92,"@type":93},"Damian","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What condition does the case describe and why is it dangerous?","Question",{"text":112,"@type":113},"The case describes myxedema coma, an extreme, life-threatening emergency from untreated severe hypothyroidism that can cause multisystem dysfunction and high mortality even with prompt treatment.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What symptoms and findings led to suspecting myxedema coma?",{"text":117,"@type":113},"The patient had reduced consciousness with hypotension and hypothermia, extensive lower limb edema, and laboratory evidence of severe hypothyroidism with markedly elevated TSH and low free T4.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the patient treated and how did the patient respond?",{"text":121,"@type":113},"Treatment included intravenous hydrocortisone, nasogastric levothyroxine (with later addition of intravenous liothyronine after endocrinology discussion), antibiotics, and supportive measures such as cautious rewarming and fluid resuscitation. Consciousness improved within 48 hours and thyroid function normalized gradually.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},454243,1791033695,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},137451208677,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review began 11/11/2025  \nReview ended 11/18/2025  \nPublished 12/07/2025  \n© Copyright 2025  \nMansoor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98621  \nOpen Access Case Report  \nMyxedema Coma as the Initial Presentation of Undiagnosed Hypothyroidism: A Rare but Reversible Emergency  \nRabia Mansoor 1 , Maheen Iqbal 2 , Tushaar Kakkar 3, Aymen Bader 4 , Taha Elsahy 2  \n1. General Medicine, Peterborough City Hospital, Peterborough, GBR 2. Acute Medicine, Peterborough City Hospital, Peterborough, GBR 3. Internal Medicine, Peterborough City Hospital, Peterborough, GBR 4. Acute Medicine, Royal Derby Hospital, Derby, GBR  \nCorresponding author: Maheen Iqbal, [maheen.iqbal@nhs.net](maheen.iqbal@nhs.net)  \nAbstract  \nMyxedema coma is a rare, life-threatening endocrine emergency representing the extreme manifestation of untreated hypothyroidism. It usually presents with nonspecific symptoms such as confusion, hypothermia, and bradycardia, which can lead to delayed recognition, particularly in elderly patients with multiple comorbidities. We report the case of a 77-year-old man with hypertension, stage 4 chronic kidney disease, anemia of chronic disease, myeloma, and prostate cancer who presented with reduced consciousness following a period of increasing lethargy and confusion. On arrival, he was hypotensive and hypothermic with a Glasgow Coma Scale (GCS) score of 8/15 and extensive lower limb edema, extending up to the abdomen. Laboratory investigations revealed severe hypothyroidism (thyroid-stimulating hormone (TSH)>99 .9 mU/L; free thyroxine (T4) 8 pmol/L) and mild infection. A diagnosis of myxedema coma was made, and he was treated with intravenous hydrocortisone, nasogastric levothyroxine (later addition of intravenous liothyronine after discussion with the endocrinology team), antibiotics, and supportive measures, including cautious rewarming and fluid resuscitation. His level of consciousness improved within 48 hours, and thyroid function gradually normalized. The case illustrates how myxedema coma may be the first manifestation of previously undiagnosed hypothyroidism and highlights the diagnostic challenge posed by overlapping comorbidities.  \nCategories: Emergency Medicine, Internal Medicine, Endocrinology/Diabetes/Metabolism  \nKeywords: endocrinology, glasgow coma scale (gcs), laboratory investigations, myxedema coma, thyroid-stimulating hormone (tsh)  \nIntroduction  \nMyxedema coma, also known as myxedema crisis, is an extreme, life-threatening presentation of severe hypothyroidism and remains a medical emergency. It denotes a state of profound metabolic derangement  \nand multisystem dysfunction in the setting of longstanding untreated or severely decompensated  \nhypothyroidism [1] . The condition can affect any age group, but significantly higher morbidity is seen in  \nelderly patients, and it carries a high mortality rate even with prompt treatment and diagnosis [2] .  \nAlthough the eponym includes \"coma \", it can present with a spectrum of neurological and non-neurological symptoms. The clinical presentation is often nonspecific and may overlap with other causes of altered level of consciousness, sepsis, and multi-organ dysfunction, which contributes to diagnostic delay [3] . Features can include hypothermia, bradycardia, hypotension, hyponatremia, hypoventilation with carbon dioxide  \n(CO₂) retention, and generalized non-pitting edema [4] .  \nTriggers for decompensation in hypothyroid patients often include recurrent illnesses such as infection or sepsis, extreme cold exposure, sedative use, cardiovascular events, or metabolic disturbances, all of which  \ncan precipitate decompensation in already susceptible patients [5] .  \nA systematic survey published in 2025 estimated a mortality rate","cbCaikFMRwBHMBME","https://ap.wps.com/l/cbCaikFMRwBHMBME","pdf",2309832,"English","# Introduction\n## Case Presentation\n## Management and Outcome\n## Discussion","[{\"question\":\"What condition does the case describe and why is it dangerous?\",\"answer\":\"The case describes myxedema coma, an extreme, life-threatening emergency from untreated severe hypothyroidism that can cause multisystem dysfunction and high mortality even with prompt treatment.\"},{\"question\":\"What symptoms and findings led to suspecting myxedema coma?\",\"answer\":\"The patient had reduced consciousness with hypotension and hypothermia, extensive lower limb edema, and laboratory evidence of severe hypothyroidism with markedly elevated TSH and low free T4.\"},{\"question\":\"How was the patient treated and how did the patient respond?\",\"answer\":\"Treatment included intravenous hydrocortisone, nasogastric levothyroxine (with later addition of intravenous liothyronine after endocrinology discussion), antibiotics, and supportive measures such as cautious rewarming and fluid resuscitation. Consciousness improved within 48 hours and thyroid function normalized gradually.\"}]","Myxedema Coma as the Initial Presentation of Undiagnosed Hypothyroidism: A Rare but Reversible Emergency | PDF",1790740389,13]