Patient handout

Myxedema coma

PRODUCTION

1. Your condition

This handout is for myxedema coma. Your care team identified this based on: ams + hypothermia + bradycardia (eta 2018 consensus; wall jcem 2000).

Other reasons your team may use this plan: core temperature <35 c (mathew thyroid 2011); tsh markedly elevated + ft4 low (ata 2014 jonklaas); known hypothyroidism with missed levothyroxine + acute illness (eta 2018 consensus).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
hydrocortisone	100 mg IV bolus, then 100 mg IV q8h × 7 days then taper	IV	q8h	ATA 2014 + ETA 2020 — give BEFORE T4 to prevent precipitating adrenal crisis (T4 increases cortisol clearance); 50% have concurrent AI

Plan: Myxedema coma — 5-pillar (steroid first → T4 ± T3 → warming → supportive → trigger)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

AMS + hypothermia + severe hypothyroid lab pattern with no HC given (ETA 2018 consensus; ATA 2014)(life-threatening)
Core temp <32°C (ETA 2018 consensus)
Na <120 with seizure or coma (ETA 2018 consensus)(life-threatening)
pH <7.35 + PaCO2 >50 with depressed GCS (ETA 2018 consensus)(life-threatening)
Glucose <70 mg/dL (ETA 2018 consensus)
New arrhythmia or chest pain after T3 administration (ETA 2018 consensus; ATA 2014)

5. Follow-up

Endo within 1 wk; titrate PO levothyroxine; education on adherence + sick-day continuation; address precipitant prevention; review medications causing hypothyroidism (ATA 2014 Jonklaas; NICE 2019)

6. Sources

Guideline: 2014 ATA Hypothyroidism Guideline + 2020 ETA/BTA Myxedema Coma Consensus + 2024 ATA Position Statement on Severe Hypothyroidism + Popoveniuc 2014 score