From the Guidelines
Myxedema coma is a life-threatening emergency that requires immediate admission and aggressive management with thyroid hormone replacement and supportive care. The treatment of myxedema coma involves several key components, including thyroid hormone replacement, supportive care, and management of precipitating factors.
- Thyroid hormone replacement typically involves intravenous levothyroxine (T4) and possibly liothyronine (T3) as well, with the goal of rapidly normalizing thyroid hormone levels 1.
- Supportive care is critical and includes measures such as mechanical ventilation, careful fluid management, and passive warming to avoid hypothermia, as well as treatment of any underlying infections or other precipitating factors.
- Stress-dose glucocorticoids, such as hydrocortisone, should also be administered until adrenal insufficiency can be ruled out, as it is a common coexisting condition in patients with severe hypothyroidism 1.
- The use of intravenous levothyroxine dosing, steroids, and supportive care, as outlined in the management of grade 3-4 hypothyroidism, is also applicable to the treatment of myxedema coma, with the goal of rapidly resolving symptoms and preventing life-threatening consequences 1.
- Inpatient endocrinology consultation can assist with the management of myxedema coma, including the dosing of intravenous levothyroxine and the administration of supportive care, to help improve outcomes in these critically ill patients.
- The mortality rate for myxedema coma remains high, making early recognition and intervention crucial for survival, and highlighting the need for prompt and aggressive treatment in patients with this condition.
From the FDA Drug Label
Myxedema Coma Myxedema coma is usually precipitated in the hypothyroid patient of long standing by intercurrent illness or drugs such as sedatives and anesthetics and should be considered a medical emergency. An intravenous preparation of liothyronine sodium is marketed under the trade name Triostat® for use in myxedema coma/precoma
The treatment for myxedema coma is an intravenous preparation of liothyronine sodium, marketed under the trade name Triostat® 2.
- Key points:
- Myxedema coma is a medical emergency
- Treatment involves intravenous liothyronine sodium (Triostat®)
- The condition is usually precipitated by intercurrent illness or certain drugs in hypothyroid patients.
From the Research
Treatment of Myxedema Coma
The treatment of myxedema coma typically involves the administration of thyroid hormone replacement therapy, as well as supportive care to manage the patient's symptoms and prevent further complications.
- The use of intravenous levothyroxine (LT4) is considered the standard therapy for myxedema coma in many countries 3.
- However, in some cases, oral levothyroxine may be used as an alternative, especially in resource-limited settings where intravenous LT4 is not available 4, 5.
- The dosage of levothyroxine used in the treatment of myxedema coma can vary, but a common approach is to start with a loading dose of 200-500 μg, followed by a maintenance dose of 50-100 μg per day 6, 4.
- In addition to levothyroxine, some patients may also require treatment with liothyronine (T3), which can be administered in combination with levothyroxine to help rapidly correct the patient's thyroid hormone levels 6.
- Supportive care for myxedema coma may include measures such as:
- Warming the patient to prevent hypothermia
- Providing oxygen therapy to prevent hypoxemia
- Administering fluids and electrolytes to prevent dehydration and electrolyte imbalances
- Using vasopressors to support blood pressure
- Implementing measures to prevent infection and sepsis
Special Considerations
- The treatment of myxedema coma should be individualized to the patient's specific needs and circumstances.
- Patients who are refractory to traditional treatments may require alternative approaches, such as the use of oral levothyroxine or combination therapy with liothyronine 7.
- Early recognition and treatment of myxedema coma are critical to preventing morbidity and mortality, and patients who are suspected of having this condition should be promptly evaluated and treated by a healthcare professional 7, 3.