Zulfigar Ali Bhatti.
Myxedema Coma.
Pak Armed Forces Med J Jan ;54(1):132-3.

A 30 years old lady was brought in emergency with history of unconsciousness of 4 hours duration. There was no history of fits, head injury, fever, headache, vomiting, intoxication or drug abuse. She was not suffering from diabetes mellitus, hypertension, cariac or thyroid disease. On examination, she was in deep coma and pupils were equal and reactive. Her pulse was 72/min, Temp 98 F, and BP was 125/85 mm Hg. Both fundi were normal. Her neck was supple.. Both planters were down going. Generalized hyporeflexia was noted. Quick systemic examination review revealed no obvious abnormality. Urgent blood sugar by glucometer showed marked hypoglycemia 24 mg/dl. She became fully conscious after administration of 200 ml of 25% glucose. Patient was interviewed; she presented history of cold intolerance, impairment of memory, menorrhagia and hoarsening of voice for the last few years. Review of history provided clues to exclude hypothyroidism. On examination, she had typical features of frank hypothyroidism, coarse faces, dry skin, sparse hair, and relaxation of tendon jerks. After taking blood sample for thyroid profile, thyroxine (50ug) one tablet was started. Next day again she became unconscious, repeat blood sugar was normal, also developed bradycardia, hypothermia, and hypoventilation. She was then treated as a case of myxodema with high dose thyroxine, broadspectrum antibiotics and parental steroids. Additional blankets and warm room maintained her normal body temperature.

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