Myxedema coma may be precipitated in a hypothyroid patient by a number of factors. Identification of the cause is important so that it can be corrected.


Many cases occur in the elderly during the winter, with the patient unable to respond to impending hypothermia.



(1) physiologic or metabolic stress

(2) altered release, protein binding or metabolism of thyroid hormones


Conditions associated with physiologic and/or metabolic stress:

(1) extensive burns

(2) surgery or trauma

(3) hypothermia

(4) hypoglycemia

(5) acute hemorrhage

(6) hypercarbia (hypercapnia)

(7) stroke

(8) acute infection (pneumonia, urinary tract infection, sepsis, etc.)

(9) acute myocardial infarction


Medications that can precipitate myxedema coma:

(1) amiodarone

(2) general anesthesia (often mixed with major surgery or trauma)

(3) barbiturates

(4) beta blockers

(5) lithium

(6) diuretics

(7) narcotic analgesics

(8) phenothiazines

(9) phenytoin

(10) rifampin

(11) benzodiazepines or other tranquilizers


Failure to maintain thyroid replacement therapy while hospitalized can result in myxedema coma, especially if there is significant metabolic stress.


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