Introduction:

Myxedema coma is the rarest and most extreme manifestation of hypothyroidism in adults. It is more frequent in older women and is associated with various clinical manifestations including diseases with systemic involvement, such as heart failure, pulmonary thromboembolism, and atrial fibrillation in unstable patients.

Case presentation:

A 73-year-old female patient with a history of heart failure, hypertension and overweight, presented functional deterioration, dyspnea at rest, tachypnea, tachycardia, desaturation, generalized edema, distal cyanosis, and jugular venous pressure. Laboratory tests showed mild anemia, normal blood glucose and electrolytes, azotemia with impaired renal function, TSH: 100 μUI/ml, free T4: 0.21 ng/dL, atrial fibrillation with accelerated ventricular rhythm and high lactate level in blood. Based on the findings, heart failure associated with de novo myxedema coma was diagnosed, as well as pulmonary thromboembolism associated with signs of right systolic dysfunction. The patient's condition gradually improved with hormone replacement therapy, heart failure treatment, and anticoagulation.

Conclusion:

Myxedema coma is a rare and extreme form of hypothyroidism. It is associated with high mortality and morbidity rates because it has severe systemic manifestations. Timely diagnosis and early implementation of supportive and specific treatment, especially with aggressive thyroid hormone replacement therapy and intensive care unit monitoring, help improve the prognosis of patients.

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