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Thursday, June 27, 2019

Successful treatment of myxedema coma with a combination of levothyroxine and liothyronine



Kazuhiro Ueda, Atsushi Kiyota, Mariko Tsuchida, Mikako Okazaki, Nobuaki Ozaki
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Keywords: Levothyroxine, Liothyronine, Myxedema coma
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2019 Volume 66 Issue 5 Pages 469-474

DOI https://doi.org/10.1507/endocrj.EJ18-0469
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References (21)
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Abstract
Myxedema coma is a rare endocrine emergency resulting from the decompensation of severe hypothyroidism, which is associated with a high mortality rate. It is characterized by the deterioration of mental status, hypothermia, hypotension, hyponatremia, and hypoventilation. Early disease diagnosis and advancements in intensive supportive care have reduced the mortality rate. Besides intensive supportive care, appropriate management of the underlying thyroid hormone deficiency is essential. However, as the disease is rare and unrecognized, evidence-based treatment of myxedema has not yet been established in many countries. An 84-year-old Japanese man with a history of Hashimoto's thyroiditis was referred to our hospital. On arrival, conscious disturbance, hypothermia, hypotension, and hypoventilation were observed. He had discontinued thyroid hormone replacement therapy for a year. He was diagnosed with myxedema coma. Immediately, he received intensive supportive care and a combination therapy of 200 μg levothyroxine and 50 μg liothyronine until the fifth hospital day. Subsequently, monotherapy with levothyroxine was continued at a dose of 150 μg daily. The thyroid hormone level reached the normal range a few days later, and cardiovascular disease did not develop during hospitalization. This case demonstrated the efficacy of the combination of levothyroxine and liothyronine in treating myxedema coma.

References (21)
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2 Rodriguez I, Fluiters E, Perez-Mendez LF, Luna R, Paramo C, et al. (2004) Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution. J Endocrinol 180: 347–350.

3 Beynon J, Akhtar S, Kearney T (2008) Predictors of outcome in myxoedema coma. Crit Care 12: 111.

4 Dutta P, Bhansali A, Masoodi SR, Bhadada S, Sharma N, et al. (2008) Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Crit Care 12: R1.

5 Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, et al. (2014) Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid 24: 1670–1751.

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