Hypothermic Coma in Myxoedema
Authors: M. Malden
Journal: BMJ (1955)

The first mention of death in hypothermic coma due to myxoedema appeared in 1879 in St. Thomas's Hospital Reports.The patient was under the care of Dr. William Ord, who in 1877 had coined the term " myxoedema."In 1888 the Report on Myxoedema of the Clinical Society of London drew attention to the subnormal tempcratures found in myxoedematous subjects and the importance of the environmental warmth for their wel- fare.G. R. Murray (1899), describing in the Goul- stonian Lectures the treatment of myxoedema by ex- tract of dried thyroid, stated: " One of the earliest signs of improvement is in the return of the temperature to the normal level."This rise in temperature could first be observed during the second week of treatment.Since then relatively little attention has been paid to the severe hypothermia in myxoedematous subjects until the papers of Le Marquand et al. (1953) and Summers (1953) appeared describing hypothyroid patients who had low temperatures before death.The fact that Summers could quote five instances in the space of two years suggests that the condition is not too uncommon.This communication reports three further cases of hypothermic coma in myxoedema.Cam 1 A housewife aged 60 was admitted to the Derbyshire Royal Infirmary on January 22, 1953, under the care of Dr. D. V. Hubble.It was impossible to obtain a history from the patient because of her poor cerebration.Her relatives stated that in 1943 she suffered from an illness in which her eyes became prominent.After a while her eyes returned to normal and she started to gain weight.About 1949 she became forgetful, stubborn, and lethargic, and com- plained bitterly of always feeling cold.A year before admission, she was confused and drowsy for a period of time, but had eventually reverted to her previous state.For a few weeks before admission she complained of breath- lessness.For six days she had been confused and dis- orientated.On admission, though she was conscious and could respond to simple questions 'and requests, her cerebration, speech, and movements were slow.Her voice was deep and croaking.There was a reddish-blue discoloration of her cheeks on a background of pallor.The outer parts of the eyebrows were lost, the scalp hair was sparse and coarse, and the axillary and pubic hair were scanty.The tongue was enlarged and protruded.Supraclavicular pads of fat were present, together with myxoedematous deposits in the skin, which was dry, cold, and finely scaling.The coldness of the skin of the trunk, even after some time in a warm hospital bed, was a striking feature.The pulse rate was 54 and the blood pressure 130/90.The heart sounds were difficult to hear and there was no congestion of the jugular veins, but marked pitting oedema of the legs and sacral region was present.The chest was resonant and there were rhonchi and rales at both bases.All tendon reflexes were diminished and plantar responses were equivocal.Investigations on Admission.-Haemoglobin,112%; R.B.C., 4,720,000 ; W.B.C., 4,100 ; E.S.R., 1 mm.; haematocrit, 53%/ ; alkali reserve, 71 ml.C02 per 100 ml.plasma; eosino- phils less than 50 per c.mm. Urine, pH 6.2; fair amount of albumin; culture, no growth.For biochemical findings see Table .At first the patient was conscious and not distressed, took food and fluids, and was reasonably co-operative.Twenty