Myxedema Coma or Crisis Medication

  • Author: Elena Citkowitz, MD, PhD, FACP; Chief Editor: George T Griffing, MD   more...
 
Updated: Nov 23, 2011
 

Medication Summary

The goals of pharmacotherapy are to increase thyroid hormone levels, reduce morbidity, and prevent complications.

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Thyroid hormones

Class Summary

Immediate administration of intravenous levothyroxine is necessity if myxedema coma/crisis is considered likely. Controversy exists regarding whether additional treatment with T3 is necessary. When the patient is eating and ambulating, oral T4 may be substituted.

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Levothyroxine (Synthroid, Levoxyl)

 

In active form, influences growth and maturation of tissues. Involved in normal growth, metabolism, and development. IV dosage form has a long half-life (may be administered qd and is the preferred route of administration in patients with myxedema coma/crisis because GI tract absorption may be compromised). Preferred by many authorities, because the onset of action is slow and sustained, making adverse effects less likely to occur and serum levels easier to monitor. Administering only T4 assumes normal conversion to T3 by deiodinase activity, which is usually compromised in severe illness. IV dose of T4 is approximately one half to two thirds of the PO dose. Lower doses recommended if patient has uncontrolled atrial arrhythmia or recent MI.

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Liothyronine (Cytomel, Triostat)

 

Synthetic form of the natural thyroid hormone, T3, converted from T4. T3 is the active form, but because peripheral conversion of T4 to T3 is compromised in patients who are hypothyroid, some authorities suggest combined IV T4 and T3 in these patients. However, patients with cardiovascular disease are at greater risk of arrhythmia and infarction.

T3 has a short half-life and must be administered q8h. Because of concerns about abrupt onset and fluctuating concentrations in tissues, experts advise coadministration of T3 with T4.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

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Hydrocortisone (Solu-Cortef, Hydrocortone)

 

DOC because of mineralocorticoid activity and glucocorticoid effects. Patients presenting with myxedema coma/crisis may have adrenal insufficiency, and stress doses of IV steroids must be administered along with initial thyroid replacement until adrenal function has been determined to be normal.

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Contributor Information and Disclosures
Author

Elena Citkowitz, MD, PhD, FACP  Clinical Professor of Medicine, Yale University School of Medicine; Director, Cholesterol Management Center, Director, Cardiac Rehabilitation, Department of Medicine, Hospital of St Raphael

Elena Citkowitz, MD, PhD, FACP is a member of the following medical societies: American College of Physicians, American Heart Association, National Lipid Association, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephanie L Lee, MD, PhD  Associate Professor, Department of Medicine, Boston University School of Medicine; Director of Thyroid Health Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Fellow, Association of Clinical Endocrinology

Stephanie L Lee, MD, PhD is a member of the following medical societies: American College of Endocrinology, American Thyroid Association, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Romesh Khardori, MD, PhD, FACP  Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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