A Rare Presentation of Myxedema Coma Complicated by Acute Coronary Syndrome Successfully Managed With Oral Levothyroxine

Myxedema coma is a rare, life-threatening complication of severe hypothyroidism. While cardiovascular manifestations such as bradycardia and pericardial effusion are common, acute coronary syndrome (ACS) as a presenting feature is exceedingly rare. We report the case of a 65-year-old man with underlying hypertension who presented with features of heart failure, altered mental status, and chest pain. He was found to have severe hypothyroidism with myxedema coma and concurrent ACS. In a resource-limited setting, he was successfully managed with oral levothyroxine alongside standard supportive measures. His condition gradually improved over the course of a week, with significant recovery noted at follow-up. This case illustrates a rare manifestation of myxedema coma complicated by ACS, successfully managed without intravenous thyroid hormone therapy. Both myxedema coma and ACS are life-threatening medical emergencies that require a high index of suspicion for timely diagnosis, especially when they occur simultaneously in a single patient. Delayed recognition and intervention significantly increase the risk of mortality.