An 82-year-old woman found semiconscious at home has temperature 34.2°C, bradycardia 48/min, dry skin, and delayed relaxation of ankle jerks. Glucose is 58 mg/dL and she has a history of radioiodine therapy. Along with supportive care, what is the correct drug regimen?

• A Oral levothyroxine alone once she regains consciousness
• B IV hydrocortisone followed by IV levothyroxine loading dose ✓
• C IV levothyroxine alone, withholding steroids until cortisol results return
• D IV triiodothyronine monotherapy at full replacement dose

Explanation

Myxedema coma carries high mortality and is treated empirically with IV levothyroxine (loading dose around 200 to 400 mcg) plus hydrocortisone, because coexisting adrenal insufficiency cannot be excluded and giving thyroid hormone alone can precipitate adrenal crisis. Waiting for cortisol levels delays life-saving therapy, and oral absorption is unreliable in coma.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.