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Myxoedema coma — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesMyxoedema comaSCE Acute Medicine

A 81-year-old woman is assessed on the acute medical unit. She is hypothermic, bradycardic and drowsy with longstanding hypothyroidism. Sodium is 119 mmol/L and there is hypoventilation. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: E — Request urgent senior critical care review

Request urgent senior critical care review is the best answer because myxoedema coma is a life-threatening endocrine emergency requiring critical care, thyroid hormone and steroid cover. Start therapeutic anticoagulation while awaiting imaging is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: It often presents as decompensated hypothyroidism rather than true coma.

Reference: Society for Endocrinology endocrine emergency guidance