Myxoedema coma

Profound hypothyroidism typically presenting with hypothermia, bradycardia and impaired level of conciousness.

Is the patient known to have long standing hypothyroidism? 

The majority of patients presenting with myxoedema coma have long standing hypothyroidism for which treatment has been recently interrupted.

Has there been a recent change in the patient's medication? 

Myxoedema may be precipitated by a sudden interruption in long standing levothyroxine replacement, or rarely by the addition of interfering medications such as iron or calcium containing compounds which may delay its absorption.

Has the patient been unwell recently with other severe illness?

Myxoedema may also be triggered by intercurrent illness such as urinary or chest infection, myocardial infarction, or stroke.

Has there been any other recent change in the patient's circumstances? 

If the patient has recently moved for example into residential care, their medication may have unwittingly been changed.

Does the patient live alone and do they usually receive any social assistance? 

Climate induced hypothermia is a common trigger for myxoedema. This is more likely to impact the elderly patient living alone in winter.

Has the patient been exposed to any sedatives or phenothiazines recently?

Sedation particularly with phenothiazines may precipitate myxoedema.

Has the patient complained of typical features of hypothyroidism prior to this presentation? 

Dry cool skin, constipation, tiredness, weight gain and hair loss are typical features suggesting long standing hypothyroidism. See hypothyroidism pages for full assessment.

Is there any family or personal history of thyroid dysfunction, pernicious anaemia, vitiligo, Addison’s disease, alopecia, diabetes or coeliac disease?

Any of these may be associated with auto-immune thyroid dysfunction.