Central hypothyroidism with myxoedema: a less known but clinically challenging presentation.

Kirandeep Kaur, Kavita Kadian, Nisha Batra, Kalyani Sridharan

BMJ case reports 2022 Sep 13

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Myxoedema can have a variety of presentations, from mild cognitive impairment to psychosis, to overt coma. While majority of cases have primary hypothyroidism as the underlying aetiology, very few cases have central hypothyroidism. We report two patients who presented with myxoedema and were diagnosed with central hypothyroidism. A man in his 50s with a history of panhypopituitarism presented with hypotension, slurring of speech and psychosis that worsened to coma. He was initially treated as adrenal crisis, and on failing to improve he was later treated correctly as myxoedema coma. A woman in her 30s presented with bradykinesia and shock and was diagnosed with Sheehan's syndrome based on hormonal and imaging features. Both patients improved with a loading dose of oral thyroxine and intravenous steroids. Central hypothyroidism presenting with myxoedema is often complicated by coexisting pituitary hormone deficiencies. A high index of suspicion is required for better treatment outcomes. © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

Kirandeep Kaur, Kavita Kadian, Nisha Batra, Kalyani Sridharan. Central hypothyroidism with myxoedema: a less known but clinically challenging presentation. BMJ case reports. 2022 Sep 13;15(9)