Myxedema coma can be be difficult to differentiate from other abnormalities, such as hypoglycemia, hyponatremia, hypercapnia, and hypoxemia, which often are associated with myxedema coma. Additonally, all of these conditions, may have contributed to the precipitation of the coma or are secondary consequences. Drugs often can be incriminated as being responsible for initiating or compounding the downward spiral of the hypothyroid patient into coma. When you arrive, you find Mr. Colskin intubated. Doll's eye movements are also intact and his neck is supple.
Reflexes seem generally poor.
The EKG shows a sinus bradycardia of 42 with low voltage QRS complexes. You and the ED doc are perplexed as to what may be going on as they prepare Mr. Colskin for a quick CT scan of the brain. Two of the cardinal features of myxedema coma are hypothermia and unconsciousness. Infection can also be precipitating cause. There may be a history of antecedent thyroid disease, thyroid hormone replacement therapy that was discontinued for no apparent reason, or therapy with radioactive iodine.