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Myxoedema coma — SCE Endocrinology MCQ

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EasyThyroidMyxoedema comaSCE Endocrinology

A 67-year-old woman has confusion and hypothermia. She has longstanding untreated hypothyroidism, sodium 122 mmol/L, glucose 3.0 mmol/L and TSH 84 mU/L with free T4 3 pmol/L. What is the most appropriate management?

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Correct answer: E — Urgent intravenous thyroid hormone with stress-dose hydrocortisone

Myxoedema coma requires urgent thyroid hormone replacement and empirical glucocorticoids until adrenal insufficiency is excluded. Delayed oral outpatient treatment is unsafe. Hyponatraemia is part of the syndrome but fluid restriction alone will not address the endocrine emergency.

Reference: Society for Endocrinology Guidance; BNF