Work

Oral Levothyroxine for Myxedema Crisis: A Case Series from a Tertiary Referral Center

Year: 2025

Type: article

Abstract: Introduction: Myxedema coma is the most severe form of decompensated hypothyroidism and represents a rare but life-threatening endocrine emergency. Standard treatment involves IV levothyroxine; however, access to this formulation is limited in many low-resource settings. This study aimed to describe the clinical characteristics, management, and outcomes of patients with myxedema coma treated with high-dose oral levothyroxine in a tertiary referral center in Colombia. Materials and Methods: We conducted an observational study of adult patients diagnosed with myxedema coma between January 2011 and December 2021 at Fundación Valle del Lili. Diagnosis was based on Popoveniuc criteria (>60 points) or presence of coma in the context of hypothyroidism. Data were collected from electronic medical records. All patients received oral levothyroxine, and clinical, laboratory, and outcome variables were analyzed. Results: Twelve patients were included (median age 66 years; 50% female). The most common precipitating factor was acute infection (41.6%). All patients received an oral loading dose of levothyroxine (median 500 µg), followed by high-dose maintenance therapy. Normalization of free T4 was observed in all patients by the fourth day. The intensive care unit admission rate was 100%, with a median stay of 11 days. Vasopressor support was required in 58.3%, and in-hospital mortality was 25%. Conclusion: High-dose oral levothyroxine was effective in achieving early biochemical recovery in patients with myxedema coma. In settings where IV formulations are unavailable, oral therapy represents a viable and potentially life-saving alternative.

Source: Journal of the Endocrine Society

DOI: 10.1210/jendso/bvaf202