EndocrinologyEmergency Medicine
Myxoedema Coma
Decompensated severe hypothyroidism — hypothermia, hypotension, hypoventilation, ALOC. IV levothyroxine + hydrocortisone, supportive care.
Source: Society for Endocrinology Emergency Guidance
Step 1 of ~3
info
Recognise
Severe hypothyroidism with multi-organ decompensation. Triad: hypothermia (often <34°C), ALOC/coma, precipitant (infection, MI, cold exposure, drugs — sedatives/opiates, surgery, missed medication). Other: bradycardia, hypotension, hypoventilation, hyponatraemia, hypoglycaemia, oedema (non-pitting). Mortality 30–40%. Bloods: TSH (↑↑), fT4 (↓), cortisol (random; before steroid), glucose, U&E, FBC, ABG, blood culture, lactate, CK.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Hydrocortisone (ICU — Stress Dosing) · Corticosteroid (ICU/Septic Shock)
- Hydrocortisone (Topical) · Mild Topical Corticosteroid
- Clotrimazole · Topical / vaginal imidazole antifungal
- Hydrocortisone butyrate · Potent topical corticosteroid
- Hydrocortisone with chlorhexidine and nystatin · Topical mild steroid + antibacterial + antifungal
- Hydrocortisone with clotrimazole · Topical mild steroid + antifungal
Pathways
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016
Decision support only. Always apply local guidelines and clinical judgement.