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Myxoedema coma — SCE Endocrinology MCQ

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HardThyroidMyxoedema comaSCE Endocrinology

A 71-year-old woman with known hypothyroidism is admitted with hypothermia, bradycardia and confusion after pneumonia. TSH is 78 mU/L, free T4 is 3 pmol/L, sodium is 126 mmol/L and random cortisol is pending. What is the most appropriate management?

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Correct answer: A — Intravenous levothyroxine with empirical hydrocortisone and supportive care

Intravenous levothyroxine with empirical hydrocortisone and supportive care is best because myxoedema coma requires urgent thyroid hormone replacement, supportive care and steroid cover until adrenal insufficiency is excluded. The alternatives are less appropriate because oral outpatient adjustment is inadequate; liothyronine without steroid cover is risky; deferring replacement is unsafe; carbimazole is the wrong direction. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG145; Society for Endocrinology emergency guidance