Treatment of Myxedema Coma

Initial Assessment and Stabilization

• The American College of Physicians recommends immediate hospitalization in an intensive care unit for aggressive supportive care, and maintaining airway, breathing, and circulation with intubation and ventilation if necessary (Glasgow Coma Score ≤8) 1
• Correcting hypoglycemia immediately if present is crucial, as recommended by the British Medical Association 2

Thyroid Hormone Replacement

• The American College of Clinical Endocrinologists suggests that elderly patients should consider lower initial doses (25-50 μg) to avoid cardiovascular complications 1

Supportive Care

• The American College of Physicians recommends glucocorticoid administration, such as giving hydrocortisone 100 mg IV every 8 hours, until adrenal insufficiency is ruled out 1

Transition to Maintenance Therapy

• The American Association of Clinical Endocrinologists recommends a typical maintenance dose of 1.6 μg/kg/day for patients without risk factors, and for elderly patients or those with cardiac disease, starting with 25-50 μg daily and titrating gradually 1
• Monitoring TSH every 6-8 weeks while titrating to goal of TSH within reference range is recommended by the Endocrine Society 1

Treatment of Myxedema Coma

Pitfalls and Caveats

• Monitor for adrenal crisis, which can be precipitated by thyroid hormone replacement in patients with concurrent adrenal insufficiency 3