Myxedema Coma Confused for Stroke; Patient Taken Off Life Support

    This case involves a ninety-four-year-old male resident of an extended care facility who presented to the emergency department with altered mental status and confusion. Nine months prior to the presentation, the patient had been hospitalized for pneumonia, chronic kidney disease, congestive heart failure, hypothyroidism, and a myocardial infarction. The patient was worked up for what was thought to be a transient ischemic attack or ‘mini-stroke.’ The patient was stabilized and sent back to the nursing home but, several days later, regressed into a coma. The patient’s family chose to remove life support measures and the patient died shortly after. A postmortem lab value revealed that the patient had been in a myxedema coma due to the hypothyroidism and a simple medication adjustment could have significantly altered his outcome.

    Question(s) For Expert Witness

    • 1. How likely is it to make a timely diagnosis of myxedma given the patient's other comorbid illnesses?

    Expert Witness Response E-000990

    Myxedema coma is rare and establishing the diagnosis requires a high index of suspicion. Myxedema coma represents the severest form of hypothyroidism and has an associated mortality rate of 30-40%. It can occur due to long-standing, untreated hypothyroidism, but is often linked to a precipitant, such as acute infection, myocardial infarction, congestive heart failure, cerebral vascular accident, trauma, or drug toxicity.

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