How should I initiate treatment for a patient diagnosed with myxoedema coma in a primary care setting?

Initiation of treatment for myxoedema coma in a primary care setting:

• Myxoedema coma is a medical emergency requiring immediate hospital admission and specialist endocrine care; it is not managed solely in primary care.
• In primary care, if myxoedema coma is suspected, urgent transfer to secondary care is essential for intensive supportive treatment, including intravenous thyroid hormone replacement and management of precipitating factors.
• Do not attempt to initiate levothyroxine treatment or other thyroid hormone replacement in primary care for myxoedema coma without specialist input, as dosing and monitoring require critical care facilities.
• Supportive measures such as maintaining airway, breathing, and circulation should be provided while arranging emergency transfer.
• Once in hospital, treatment typically involves intravenous levothyroxine and hydrocortisone, but these are beyond the scope of primary care initiation.

Therefore, the key action in primary care is rapid recognition and urgent referral to hospital rather than initiating treatment independently.

References: This approach aligns with the NICE guideline on thyroid disease management emphasizing specialist care for severe hypothyroidism and myxoedema coma, although the provided excerpts do not detail myxoedema coma management specifically, standard clinical practice and NICE guidance indicate emergency hospital management is mandatory ¹.