Abstract 122: Central hypothyroidism presenting with myxedema coma – Two case reports

Background: Myxedema can present with mild cognitive impairment to psychosis to coma. Majority of cases reported are of primary hypothyroidism with few case reports in central hypothyroidism. We report two case reports of myexedema in secondary hypothyroidism. Case Presentation: A 57-year-old man diagnosed as panhypopituitarism following a road traffic accident 8 years back, presented with hypotension and slurring of speech after stopping hormone supplements. He was started on intravenous steroids for adrenal crisis and previous dose of thyroxine but soon developed a rigid akinetic state followed by coma. He responded well to a loading dose of thyroxine and was discharged on oral steroids, thyroxine and depot testosterone. A 36-year-old female presented with altered sensorium, bradykinesia and shock. After last child birth 1 year back, she developed lactational failure and amenorrhea. Hormonal investigations showed panhypopituitarism. She improved with loading dose of thyroxine and intravenous steroids. Although empty sella is the usual finding in Sheehan's syndrome, neuroimaging in this patient revealed normal sized pituitary with multiple necrotic areas suggesting possible prolonged necrosis. Conclusion: Myxedema coma in central hypothyroidism is complicated by co-existing pituitary hormone deficiencies and early treatment initiation is important.