Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.

Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.^[1][2][3]

• Serum TSH should be measured to distinguish primary hypothyroidism from the central.
• TSH might not be so as would be expected due to the presence of concomitant severe systemic disease(“sick hypothyroid syndrome”).
• The use of certain drugs such as dopamine or glucocorticoids also decrease the levels of TSH.
• The levels of T4 and T3 (total and free fractions) will always be low.
• In all cases measure cortisol and ACTH to evaluate or rule out the presence of primary adrenal insufficiency or secondary school.
• CBC shows anemia, leucopenia, hyponatremia, increased lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and transaminases, hypercholesterolemia, increased creatinine and hypoglycemia.
• Blood gases will reveal hypoxemia, hypercapnia and acidosis.