Myxoedema Coma in a Medically Compliant Young Patient Presenting With Cardiogenic Shock and Requiring Cardiopulmonary Resuscitation

Myxedema coma, a rare and life-threatening complication of severe hypothyroidism, manifests with altered mental status, hypothermia, bradycardia, hypotension, hyponatremia, and respiratory failure, potentially leading to multisystem organ failure. Cardiogenic shock associated with myxoedema coma, resulting from impaired myocardial contractility and reduced cardiac output, is a severe complication associated with increased mortality risk. This endocrine emergency requires prompt recognition and aggressive management. We report a case of a 30-year-old female with a history of hypothyroidism and pituitary tumor resection who presented with lethargy and experienced pulseless electrical activity cardiac arrest, with return of spontaneous circulation (ROSC) after two rounds of epinephrine. Laboratory findings revealed severe hypothyroidism, elevated thyroid-stimulating hormone (TSH), and acute kidney injury. Initial management included intravenous levothyroxine, hydrocortisone, vasopressors, and mechanical ventilation for cardiogenic shock. Echocardiography demonstrated severely reduced left ventricular ejection fraction, which gradually improved with treatment. The patient's neurological status and thyroid function returned to normal over several days, emphasizing the importance of multidisciplinary care. This case underscores the critical role of early thyroid hormone replacement, titration of thyroid hormones, addressing precipitating factors like adrenal insufficiency and hypoglycemia, and providing intensive supportive care. Long-term management focused on medication adherence, patient education, thyroid hormone titration, and regular endocrinology follow-up to prevent complications of severe hypothyroidism. This report highlights the importance of rapid diagnosis and individualized treatment to optimize outcomes for patients with myxedema coma, a condition associated with high mortality rates despite appropriate intervention.