A case report on Myxedema Coma: Is enteral route as good as intravenous levothyroxine in an Indian intensive care setting?

Myxedema coma is a rare life-threatening clinical condition in patients with longstanding severe untreated hypothyroidism, wherein adaptive mechanisms fail to maintain homeostasis. We report a rare case involving a 35-year-old male with an intellectual disability, who arrived at our intensive care unit in a comatose state. Following a thorough examination of numerous potential differential diagnoses, the patient was determined to be suffering from myxedema coma a rare presentation. The patient responded well to tablet levothyroxine administered via a nasogastric tube, achieving the desired positive outcome. Due to the exceptionally low incidence of this condition in our country, we were initially diverted into considering more frequent causes of coma. The coexistence of a pre-existing intellectual disability, coupled with factors like Herpes Zoster infection, hyponatremia, and bradycardia, posed hurdles in promptly diagnosing this condition, which was further complicated by its rarity. This case report describes the management of myxedema coma and depicts the clinical and logistic challenges faced while managing this case. This case also emphasizes the importance of readiness and the ability to adapt treatment to individual circumstances.