Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc
Journal website http://www.jofem.org

Case Report

Volume 9, Number 3, June 2019, pages 71-76

A Case of Myxedema Coma Confounded by Dementia and Hypokalemia

Figures

Figure 1.
Figure 1. Pretibial pitting edema.
Figure 2.
Figure 2. ECG showing ventricular rate 71/min, QTc: 633 ms, normal sinus rhythm (NSR), T wave flattening and prolonged QT.
Figure 3.
Figure 3. Hypothyroid facies, dry skin, coarse hair, saddle nose, periorbital edema, ptosis and apathetic appearance.
Figure 4.
Figure 4. No pleural effusion or cardiomegaly on chest X-ray.
Figure 5.
Figure 5. Brain CT showing cortical atrophy.
Figure 6.
Figure 6. Brain CT showing prominent sulci.

Table

Table 1. Relevant BMP/CBC/Thyroid Labs Examination at Admission
 
ValueReference range
Sodium135 mmol/L135 - 145 mmol/L
Potassium2.0 mmol/L3.5 - 5.1 mmol/L
Chloride78 mmol/L98 - 108 mmol/L
CO246 mmol/L22 - 34 mmol/L
Blood urea nitrogen13 mg/dL7 - 18 mg/dL
Creatinine0.80 mg/dL0.60 - 1.30 mg/dL
Glucose86 mg/dL70 - 110 mg/dL
Calcium7.9 mg/dL8.4 - 10.6 mg/dL
Magnesium2.0 mg/dL1.3 - 2.1 mg/dL
Phosphorus2.2 mg/dL3.0 - 4.5 mg/dL
White blood cell6.8 × 103/mm33.5 - 11 × 103/mm3
Hemoglobin11.7 g/dL12 - 16 g/dL
Hematocrit33.2%36-46%
Platelets228 × 103/mm3150 - 440 × 103/mm3
Creatinine-phosphokinase302 U/L38 - 234 U/L
Thyroid-stimulating hormone82.2 U/mL0.34 - 5.6 U/mL
Free thyroxine (T4)< 0.07 ng/dL0.8 - 1.8 ng/dL
Cortisol20.60 µg/dL10 - 20 µ/dL
Arterial blood gas (nasal cannula on room air)
  pH7.637.35 - 7.45
  pCO239.6 mm Hg35 - 45 mm Hg
  pO256 mm Hg80 - 100 mm Hg
  HCO341.9 mmol/L22 - 26 mEq/L
  SpO292%95-100%