Sluggish Myra — Myxedema Coma
Everything slows: hypothermia, bradycardia, hypoventilation
Myra slows down for years and everyone calls it aging. Then a cold snap and a missed month of levothyroxine drop her into a sleep no one can wake her from.
Myra's hypothyroidism decompensates in winter. Hypothermia without shivering, bradycardia, hypoventilation with CO₂ retention, hyponatremia and coma. IV levothyroxine, passive rewarming, airway support and steroids until adrenal insufficiency is excluded.
Read Sluggish Myra's full story →The story arc
The setup
Levothyroxine she could not afford to refill, and a January cold snap in a poorly heated apartment.
The turn
Family reports she is puffy-faced, constipated, hoarse and sleeping eighteen hours a day.
The crisis
Temperature 33.9°C without shivering, heart rate 44, respirations 8 and shallow, sodium 122, unresponsive.
The save
IV levothyroxine, airway support, passive rewarming with blankets, and hydrocortisone until adrenal insufficiency is ruled out.
NCLEX study section — Myxedema Coma
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.