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Myxoedema coma — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesMyxoedema comaSCE Acute Medicine

An 84-year-old woman is admitted from a care home with hypothermia, bradycardia and reduced consciousness. Sodium is 121 mmol/L, glucose is 3.2 mmol/L and ABG shows hypoventilation. TSH is markedly raised and free T4 is very low. What is the most appropriate next step in management?

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Correct answer: C — Give intravenous thyroid hormone with hydrocortisone and organ support

Hypothermia, hypoventilation, bradycardia, hyponatraemia and reduced consciousness indicate myxoedema coma. Give parenteral thyroid hormone in monitored critical care and administer stress-dose hydrocortisone until adrenal insufficiency is excluded. Correct hypoglycaemia, ventilatory failure and the precipitating infection while avoiding rapid active rewarming.

Reference: https://www.nice.org.uk/guidance/NG145/chapter/recommendations