Sat27November0445PM 20

An 80-year-old female presents to the Emergency Department acutely unwell after being found unresponsive, on the floor of her house, by her son. She had a past history of hypothyroidism and of taking thyroxine daily. However, her compliance with treatment is questionable.

On examination she was unrousable with a Glasgow Coma Scale of 6/15, had a central temperature of 34°C, oxygen saturations of 95% on air, a pulse of 44 beats per minute and a blood pressure of 100/80 mmHg. There were no specific localising signs on neurological examination, but both plantars were extensor.

Prior to results of her emergency blood tests being available, what is the most appropriate immediate treatment for this patient?

(Please select 1 option)

Oral thyroxine via NG tube

Intravenous normal saline

Intravenous thyronine (T3) and hydrocortisone This is the correct answer

Intravenous hydrocortisone Incorrect answer selected

Intravenous 50% glucose

Explanation

This patient has typical features of myxoedema coma, which usually occurs in the elderly who are typically non-compliant. It carries a high mortality and should initially be treated with IV thyroid hormone - either T4 or T3 - and IV hydrocortisone even before results are obtained.

Other treatment includes rewarming. IV fluids should be used cautiously, as these patients are typically fluid overloaded.

Answer Statistics

1

3%

2

12%

3

45%

4

35%

5

7%

Times answered: 274