| Despite the rarity of this complication, it is appropriate to mention here the main lines of the treatment of myxedematous coma because it is a medical emergency, potentially lethal, and usually observed in primary care conditions. Management in the intensive care unit is necessary with supportive means for pulmonary and cardiac functions. Therapeutic principles include: a) bolus administration of 300-400 µg L-T4 either i.v. or by nasogastric tube, to be repeated once 24 h later in the absence of any clinical improvement; 100 µg L-T4 are administared daily thereafter; b) slow and careful rewarming; c) administration of 100-300 mg cortisol hemisuccinate; d) appropriate monitoring of cardio-pulmonary functions, hypoglycemia, hyponatremia, hypotension; e) treatment of intercurrent problems. Despite competent management, prognosis of myxedoma coma remains severe, fatal outcome occurring in 40% of the cases. |
