Correct!
5. All of the above
Despite a normal TSH level, her free T4 level was low at 0.19 ng/dL (normal 0.5-1.9) and her total T3 was undetectable. An ACTH stimulation test showed lack of an appropriate increase to stimulation with cortisol values 30 min post stimulation: 4.1 µg/dL and 60 minutes post stimulation: 6.4 µg/dL.
She was diagnosed with myxedema coma.
Myxedema coma is a life-threatening form of hypothyroidism with mortality approaching 40 to 50% (1,2). It is increasingly rare given the widespread screening for thyroid disease. It is most common in elderly women. Myxedema coma can be precipitated by infection, trauma, severe cold exposure and medications. Symptoms are nonspecific. Pulmonary and cardiac findings can include hypercapnia, hypoxia, laryngeal edema, bradycardia, pleural and pericardial effusions, and low cardiac output including shock. Metabolic manifestations include edema/anasarca, hyponatremia (up to 50% of cases), hypoglycemia, and hypothermia. Neurologic presentations can be those of lethargy, confusion, coma as seen here and even seizures. Constipation, abdominal pain, anorexia and nausea are common but nonspecific findings (3,4).
Treatment of myxedema coma should include the following: