Myxoedema Coma Masquerading as Acute Stroke

This report describes the management of a patient with myxoedema coma masquerading as an acute stroke (with or without ‘cold sepsis’). Myxoedema coma is an endocrine emergency occurring when physiological adaptations to untreated hypothyroidism are overwhelmed by an acute precipitant. Even promptly treated, it has an associated mortality of up to 50%. LEARNING POINTS: Early recognition of myxoedema coma is essential, however the chance of misdiagnosis remains high. Key management consists of rapid thyroid hormone replacement (intravenous T4 at 300–500 μg over 24 hours, followed by 50–100 μg daily), supportive measures and the concomitant management of triggers such as infection.