BACKGROUND
Myxedema coma is an extreme, life-threatening form of hypothyroidism that can affect patients with untreated hypothyroidism. This can occur in patients who are undiagnosed as well as patients with known hypothyroidism who are undertreated or have run out of their thyroid hormone medication. Myxedema coma is usually provoked by another medical condition, such as an infection, heart attack, stroke, and surgery, and is often seen in the winter months. Myxedema coma is characterized by the failure of many organs and body functions, for example, difficulty in keeping the body temperature warm and the heart pumping normally, and affects the mental status causing from confusion to coma. Patients with Myxedema coma need admission to the hospital and ICU care. Death from Myxedema coma is high, about 25-50%. Fortunately, Myxedema coma is rare. The authors of this study wanted to find out what are the characteristics of patients admitted to the hospital with Myxedema coma and what happens to them.

THE FULL ARTICLE TITLE
Chen DH et al. Clinical features and outcomes of myxedema coma in patients hospitalized for hypothyroidism: analysis of the United States National Inpatient Sample. Thyroid. Epub 2024 Jan 27. doi: 10.1089/ thy.2023.0559. PMID: 38279788

SUMMARY OF THE STUDY
The authors looked at 18,635 patients who were hospitalized from 2016 to 2018 with a diagnosis of hypothyroidism with and without Myxedema coma. Of these patients, 2495 (13%) had Myxedema coma. Patients with Myxedema coma, as compared to hypothyroid patients without Myxedema coma, were older, more likely to have Medicare insurance and being unhoused and more likely to present in the winter months. Patients with Myxedema coma were more likely to need assistance with breathing, including intubation to deliver oxygen, more likely to receive medications to bring the blood pressure up and more likely to need hemodialysis treatment for kidney failure. Death in hypothyroid patients with Myxedema coma was almost 10 times higher than in those without Myxedema coma (7% versus 0.7%). The stay in the hospital was longer in patients with Myxedema coma (9 days) as compared to patients without Myxedema coma (4 days). The cost of the hospitalization was not surprisingly higher, three times as much, for patients with Myxedema coma as compared to those without Myxedema coma, due to longer stay and more intensive care.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Patients with this severe form of hypothyroidism known as Myxedema coma have a high risk of dying. The health care costs to manage patients with Myxedema coma are high. Prevention of Myxedema coma in patients at risk (for example the elderly), includes prompt treatment of their hypothyroidism and complicating medical illness. Improving treatment for Myxedema coma will help decrease death.

— Susana Ebner MD

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