Clinical course of myxedema coma in an Alzheimer’s disease patient and co-founding of J wave: A case report

Myxedema coma is a rare condition and is associated with a high mortality rate. Management has been based on the medical experience due to its rarity. Here, we are presenting a case of a 78-year-old African American woman with Alzheimer's disease and primary hypothyroidism, who presented to the emergency department with altered sensorium, hypotension, severe hypothermia, and bradycardia. She was diagnosed with myxedema coma and admitted to the medical intensive care unit (ICU). Despite appropriate management, including early administration of intravenous thyroxine (FT4), the patient's hospital course was complicated. She went into multi-organ system failure, requiring multiple re-intubations due to the poor mental status. Although thyroid stimulating hormone (TSH) and T4 reached normal levels, there was no improvement in the patient's mental status which could be due to multiple factors including dementia at baseline, development of delirium and functional deconditioning later in her course. Myxedema Coma seen in elderly patients with dementia poses significant morbidity and mortality. Hence, a primary care physician or a geriatrician's role becomes crucial in maintaining proper follow-up of these patients to alleviate the above outcomes.