Hypothyroidism and Myxedema Coma Follow-up

Updated: Feb 26, 2018
  • Author: Erik D Schraga, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Further Inpatient Care

Further inpatient care is as follows:

  • Admit patients with myxedema coma to ICU.

  • Provide supportive ventilatory and hemodynamic management.

  • Treat precipitating events (eg, infection).

  • Continue rewarming as required.

  • Confirm diagnosis with laboratory testing.

  • Continue thyroid hormone replacement, and convert to oral therapy when tolerated.

  • Clinical improvement should be apparent within 24-36 hours of initiating thyroid hormone replacement.



Potential complications are as follows:

  • Treatment-induced congestive heart failure in patients with coronary artery disease

  • Myxedema coma

  • Increased susceptibility to infection

  • Megacolon

  • Organic psychosis with paranoia

  • Adrenal crisis with vigorous treatment of hypothyroidism

  • Hypersensitivity to opiates

  • Pericardial effusion and cardiac tamponade [11]



The prognosis of hypothyroidism is good with early treatment. However, once the disease has progressed to myxedema coma, the mortality rate may exceed 20% in the treated population. Relapses occur if treatment is discontinued.

The mortality rate in myxedema coma has historically been as high as 80%. Some data suggest that aggressive management and early recognition have improved the mortality rate to 15-20%. However, a more recent observational study was unable to show significant differences in outcome based on replacement therapeutic methods, with a mortality rate remaining high at 40%. [12]

The aforementioned study by Ono et al reported that, as revealed through multivariable logistic regression, a higher inhospital mortality rate in myxedema coma was associated with older age and catecholamine use (with or without steroids). [4]

A study by Sato et al suggested that in patients with heart failure, those with subclinical hypothyroidism have a worse prognosis, finding a significant increase in the rates of cardiac events and all-cause mortality in heart failure patients in the study with subclinical hypothyroidism compared with those who were euthyroid. [13]


Patient Education

Patients should be educated about the following:

  • Importance of medication compliance

  • Need for lifelong treatment

  • Watch for signs of infection

  • Watch for signs of thyrotoxicity

For patient education resources, see the Endocrine System Center, as well as Thyroid Problems and Myxedema Coma.