context: The thyroid gland, located at the front part of the neck, is responsible for making substances called thyroid hormones that are important for all body cells to work properly. In certain conditions, the thyroid becomes underactive and produces fewer amounts of its hormones, a situation called hypothyroidism. People with hypothyroidism have problems that reflect underactivity of the organs of the body, resulting in symptoms such as fatigue, feeling cold, weight gain, dry skin, and sleepiness. When the levels of thyroid hormones become very low, the symptoms get worse and can result in a serious condition called myxedema coma. Myxedema coma is a rare but life-threatening condition. People with hypothyroidism who are in or near a coma should be taken to an emergency department immediately. If you have severe hypothyroidism, then any of the following can contribute to myxedema coma: Infections, especially lung and urine infections Heart failure Stroke Trauma Surgery Drugs, such as phenothiazines, amiodarone, lithium, and tranquilizers, and prolonged iodide use Not taking prescribed thyroid medications Symptoms of hypothyroidism may include the following: Weakness Confusion or non-responsiveness Feeling cold Low body temperature Swelling of the body, especially the face, tongue, and lower legs Difficulty breathing People who have myxedema coma are in or near a coma and not able to function normally. In the emergency room, they may be treated for shock, low blood pressure, hypothermia, and electrolyte abnormalities. People who have hypothyroidism and develop fever, changes in behavior or mental status, shortness of breath, or increased swelling of the hands and feet should be taken to an emergency department. Blood tests are performed to check blood cell count, electrolytes, sugar, and thyroid hormone levels. Tests are also performed to evaluate how the liver and adrenal glands are functioning. Blood gases are evaluated to check for oxygen and carbon dioxide levels. An ECG of the heart is performed to check for disturbances in the activity of the heart. Additional tests are performed at the discretion of the treating doctor. If you have hypothyroidism, be alert to your condition. Call your doctor if you are concerned. Check your blood sugar level if you are diabetic. Warm yourself up with a warm blanket and seek help. Take your prescribed thyroid medication if you missed them earlier. People with myxedema coma are in a coma or nearly in a coma. They are not able to function normally. Friends or family members should take them to an emergency department immediately. Friends or family members should not give the person in myxedema coma any thyroid medication before taking him or her to the emergency department. If adrenal insufficiency is present, then administration of thyroxin (in the thyroid medication) will provoke an adrenal crisis. Intravenous fluids Electrolytes replacement as necessary Thyroid hormones are usually administered through a vein (intravenously or IV) to quickly correct the low thyroid hormone blood level. Oral thyroid hormone is usually not used for severe myxedema because it may take days or weeks to obtain the proper blood level, and swallowing pills may not be safe. Intravenous cortisol or other adrenal cortical hormone Warming blanket if body temperature is low Glucose supplements if the blood sugar level is low Antibiotics if an infection is present Following the start of treatment, careful monitoring, usually in the intensive care unit, is necessary. Follow-up with the doctor after discharge is important to monitor the thyroid condition and decide on the right thyroid hormone dose to be taken. Myxedema coma can be prevented with early treatment of hypothyroidism, taking thyroid medication regularly, and recognition of the warning symptoms of myxedema coma. Myxedema coma is a very serious condition that can result in death. Early and aggressive treatment can improve the outcome. American Thyroid Association Thyroid Foundation of America American Foundation of Thyroid Patients myxedema coma, hypothyroidism, under-active thyroid, underactive thyroid, thyroid gland, thyroid hormone, thyroid emergency, low thyroid hormone