Correct!
5. All of the above
Experts debate whether both T3 and T4 are needed to acutely treat myxedema coma. The onset of action of T3 is quicker, bioavailability higher and most recommend use of both. Because of the rare situations where hypothyroidism is accompanied by adrenal insufficiency (as seen in this patient), glucocorticoids are recommended while awaiting lab testing (3,4).
She was diagnosed with panhypopituitarism, myxedema coma and adrenal insufficiency. A magnetic resonance imaging MRI of the brain showed an atrophic appearance of the pituitary gland, thought due to prior ischemia or hemorrhage.
For this patient, myxedema coma with a normal TSH, low thyroxine, and associated panhypopituitarism with adrenal insufficiency was diagnosed as being from a hypothalamic or pituitary cause of the hypothyroid state, or central hypothyroidism. This is a rare etiology of hypothyroidism, seen in one of 1,000 hypothyroid patients (5). Causes include Infiltrating or compressive tumor such as a pituitary adenoma, or prior ischemia/infarct. The latter can be from pituitary apoplexy or post-partum pituitary necrosis, Sheehan syndrome.
What are the mechanisms of respiratory failure in myxedema coma?