7502 Patient Suffering from Laryngeal Edema in the Setting of Hypothyroidism

Abstract Disclosure: J. Seidenberg: None. P. Prabhu: None. M. Ansari: None. Hypothyroidism can present with many different symptoms including dry skin, weight gain, and lethargy, with severe presentations being altered mental status, bradycardia, hypotension, and myxedema coma. Rarely, hypothyroidism can present with isolated laryngeal myxedema with few cases being noted. Myxedema is defined as swelling and thickening of the skin, and airway compromise secondary to myxedema is a potentially life-threatening presentation. In this case report, the patient is a 41-year-old female with PMH of hypothyroidism, homelessness, alcohol use, and morbid obesity who presented to the ED for nausea, vomiting, abdominal pain, and throat swelling. The swelling had been present for several months and acutely worsened with voice changes on the day prior to presentation. She noted poor compliance with Levothyroxine for several months. On exam, she was found to have hoarseness, difficulty swallowing, drooling, and tenderness in anterior neck. She was admitted to ICU for airway protection observation. On her blood work, she was found to have an undetectable T4, TSH > 100 (0.45-4.5 UI/mL), and CT neck and abdomen negative for alternative causes of swelling. Laryngoscopy showing normal larynx. The patient had a Popoveniuc myxedema score of 35 with no electrolyte abnormalities. She was given racemic epinephrine with minimal effect and IV Levothyroxine 200 mcg. After 3 days of IV Levothyroxine 84 mcg and high dose Decadron, she had improvement in throat swelling and breathing. She was later discharged with Synthroid and a 5-day Decadron course. Myxedema is a potentially life-threatening presentation of hypothyroidism. Patients who have untreated hypothyroidism can have chronic myxedema with acute worsening of symptoms that put them at risk of airway compromise, even with an initially low diagnostic score. Patients should be screened on admission when they present with unknown cause of airway compromise for hypothyroidism and treated with empiric high dose levothyroxine IV followed by daily IV levothyroxine until symptom improvement and daily TSH and T3/T4 improvement. Treatment with both high dose steroids and racemic epinephrine should be initiated before diagnosis due to feasible alternative or additional causes of airway obstruction. Presentation: 6/3/2024