A “cold” case of myxedema coma

Myxedema coma (MC) represents a rare and severe manifestation of the extreme degree of longstanding and decompensated hypothyroidism. This condition affects approximately 0.22 cases per million inhabitants per year, especially women and the elderly, and its mortality remains very high, approximately 30-50%. This condition can present with altered mental status, hypothermia, bradycardia, hyponatremia, cardiomegaly, decreased cardiac output, and hypotension. Sometimes myxedema can cause respiratory depression and gastrointestinal issues like anorexia, abdominal pain, constipation, fecal retention, and paralytic ileus. These multiple clinical manifestations represent a true diagnostic challenge. MC can occur in patients with undiagnosed or undertreated hypothyroidism, and it may remain undiagnosed due to the sudden onset, the lack of reliable history in patients presenting with altered sensorium, and the overlap of symptoms with common medical conditions like sepsis, metabolic encephalopathy, and cerebrovascular events. Prompt recognition and management of MC are crucial to reducing the risk of life-threatening complications and improving patient outcomes.