Profound Hypothermia with an Empty Sella - A Myxedema Coma Case Study



CR2 (10) - Costello - Myxedemapdf

Project Title: Profound Hypothermia with an Empty Sella - A Myxedema Coma Case Study

Authors: Allison Costello MD, MBA; Megan Townsend MD, MPP; John Weeks MD; Leslie Guererro MD; Melissa Beagle MD, MPH

Program: University of Colorado Family Medicine Residency

Description: This case demonstrates the classic signs and symptoms of myxedema coma, and discusses the workup and treatment course appropriate for this condition.

Abstract: A 63 year old male with history of type 2 diabetes mellitus and remote traumatic brain injury was brought to the emergency department after being found acutely altered during a welfare check. Initial examination demonstrated profound hypothermia, bradycardia, volume overload, and acute encephalopathy. Further testing demonstrated partially empty sella turcica on head imaging, an elevated TSH, and normal T4. His TPO antibodies later were positive. Echocardiogram noted a mildly reduced ejection fraction. Broad workup included evaluation for adrenal insufficiency, carbon monoxide exposure, ingestion of substances, and environmental exposure, all of which were negative. The patient was externally rewarmed, diuresed, and received IV thyroid supplementation with drastic improvement in symptoms, and was diagnosed with hypothyroidism complicated by myxedema coma. This case demonstrates the classic symptoms of myxedema coma, and is a reminder that rapid identification and treatment of the condition may positively impact patient outcomes.

Learning Objectives: Participants will be able to… • Describe the signs and symptoms of myxedema coma • Identify the causes of empty sella syndrome • Review the treatment course for myxedema coma

Category: Case report

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