The most alarming features of myxedema coma

Dr Leonard Wartofsky is a professor of medicine at Georgetown University Hospital, chairman emeritus of the Department of Medicine at the Washington Hospital Center, and past president of the American Thyroid Association and the Endocrine Society.

What are the key diagnostic criteria for myxedema coma? What signs and symptoms are the most alarming?

Leonard Wartofsky, MD, MPH: For myxedema coma, coma itself is of course the most dramatic and clinically impressive sign, but the features that should really alert the physician and be of significant concern are hypothermia, hypotension, underlying infection that may have precipitated the coma—such as pneumonia or aspiration pneumonia—and the possibility that there are fluid accumulations in the patient that can be impeding treatment and recovery. These could be pleural effusions, ascites, or pericardial effusions.

So, it is important, whenever feasible, to obtain sufficient imaging and good physical examination to detect all of these abnormalities.