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Intravenous levothyroxine viable option for myxedema coma

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CORONADO, Calif. — Myxedema coma can be safely and effectively treated with IV levothyroxine, according to recent study findings presented at the American Thyroid Association Annual Meeting.

“Myxedema coma, a rare form of decompensated hypothyroidism, can be fatal if not diagnosed and treated promptly,” the researchers wrote.

Caroline T. Nguyen, MD, of Keck School of Medicine and the University of Southern California, and colleagues evaluated 45 patients (60% women) with myxedema coma from 2004 to 2014 to determine the safety and efficacy of treatment with 500 mcg IV levothyroxine (LT4 load).

Two-thirds of the patients presented in the fall and winter; the most common precipitating events was sepsis (42.5%). More than three-quarters of the patients were admitted to the ICU. Median free thyroxine values were 0.39 ng/L.

Thirty-eight patients with hypothyroidism had median thyroid-stimulating hormone levels of 69.28 mIU/mL.

Treatment with LT4 load was started about 27.3 hours from presentation. Of 29 patients, 20 had altered mental status within 24 hours of treatment start. No cardiovascular complications were reported and 6.7% of patients died; sepsis was the dominant cause.

“To the best of our knowledge, this is the largest case series of [myxedema coma] patients described,” the researchers wrote. “The diagnostic criteria of [hypothyroidism] symptoms/signs and [altered mental status] ± a [precipitating event] and low serum free T₄ and/or high TSH values should be used to identify patients with [myxedema coma]. LT4 load is safe and effective at reversing symptoms, particularly [altered mental status], within a short period of time (<24 hours) and should be the standard of care. The majority of patients had good outcome except for a small percentage of patients who were septic and had significant comorbidities, highlighting the importance of supportive care for successful treatment.”

For more information:

Wu KC. Oral #221. Presented at: American Thyroid Association Annual Meeting; Oct. 29-Nov. 2, 2014; Coronado, Calif.

Disclosure: The researchers report no relevant financial disclosures.