Myxoedema Coma Masquerading as Acute Stroke
  • Christopher Butter
    St Peter's Hospital, Lyne, Chertsey, Surrey, UK
  • Nazia Rashid
    St Peter's Hospital, Lyne, Chertsey, Surrey, UK
  • Rumaisa Banatwalla
    St Peter's Hospital, Lyne, Chertsey, Surrey, UK
  • Thomas FitzGerald
    St Peter's Hospital, Lyne, Chertsey, Surrey, UK


Myxoedema coma, thyroid emergencies, hypothyroidism


This report describes the management of a patient with myxoedema coma masquerading as an acute stroke (with or without ‘cold sepsis’). Myxoedema coma is an endocrine emergency occurring when physiological adaptations to untreated hypothyroidism are overwhelmed by an acute precipitant. Even promptly treated, it has an associated mortality of up to 50%.



  • Davis PJ, Davis FB. Hypothyroidism in the elderly. Compr Ther 1984;10:17–23.

  • Savage MW, Mah PM, Weetman AP, Newell-Price J. Endocrine emergencies. Postgrad Med J 2004;80(947):506–515.

  • Kearney T, Dang C. Diabetic and endocrine emergencies. Postgrad Med J 2007;83(976):79–86.

  • Dula P, Bhansali A, Masoodi SR, Bhadada S, Sharma N, Rajput R. Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Crit Care 2008;12(1):R1.

  • Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman M, Burman K, et al. A diagnostic scoring system for myxedema coma. Endocr Pract 2014;20(8):808–817.

  • Wall CR. Myxedema coma: diagnosis and treatment. Am Fam Phys 2000;62(11):2485–2490.

  • Kwaku MP, Burman KD. Myxedema coma. J Intens Care Med 2007;22(4):224–231.

  • Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res 2011;2011:493462.

  • Hylander B, Rosenqvist U. Treatment of myxoedema coma factors associated with fatal outcome. Acta Endocrinol 1985;108(1):65–71.

  • Pereira VG, Haron ES, Lima-Neto N, Medeiros-Neto GA. Management of myxedema coma: report on three successfully treated cases with nasogastric or intravenous administration of triiodothyronine. J Endocrinol Invest 1982;5(5):331–334.

  • Masin G, editor. Endocrine and metabolic medical emergencies: a clinician's guide. Chichester, UK: John Wiley & Sons; 2018.

  • McCulloch W, Price P, Hinds CJ, Wass JA. Effects of low dose oral triiodothyronine in myxoedema coma. Intens Care Med 1985;11(5):259–262.

  • Rodriguez I, Fluiters E, Perez-Mendez LF, Luna R, Páramo C, García-Mayor RV. Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution. J Endocrinol 2004;180(2):347–350.

  • Sheu CC, Cheng MH, Tsai JR, et al. Myxedema coma: a well-known but unfamiliar medical emergency. Thyroid 2007;17(4):371–372.
  • Views: 936
    HTML downloads: 150
    PDF downloads: 380

    Published: 2020-04-22
    Issue: 2020: Vol 7 No 7 (view)

    How to cite:
    Butter C, Rashid N, Banatwalla R, FitzGerald T. Myxoedema Coma Masquerading as Acute Stroke. EJCRIM 2020;7 doi:10.12890/2020_001563.

    Most read articles by the same author(s)