DOI: 10.12890/2021_002752

Hypothyroid Crisis: Oral or Intravenous Treatment? A Report of Two Cases

Authors

  • Rens Gadaen Department of Internal Medicine, Division of Endocrinology and Thyroid Centre, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
  • Roderick Tummers - de Lind van Wijngaarden Department of Internal Medicine, Division of Endocrinology and Thyroid Centre, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands

Rensgadaen@gmail.com

Keywords

Hypothyroid crisis, myxoedema coma, oral treatment

Abstract

Background: Hypothyroid crisis, or myxoedema coma, is a rare condition with high mortality and must be treated promptly. Even though it may be unfavourable, most guidelines only focus on intravenous drug administration due to lack of data on oral treatment.

Methods/Results: The course of oral treatment in two patients admitted in our hospital is described. Patients were treated with levothyroxine 1.3 µg/kg and liothyronine 25 µg twice daily, followed after 1 week with only levothyroxine 1.3 µg/kg daily. Oral treatment was successful in both patients without complications or side-effects.

Conclusions: Oral substitution is an appropriate alternative to intravenous substitution, which has potential disadvantages and is associated with higher mortality.

View the entire article

Downloads

References

  1. Wall CR. Myxedema coma: diagnosis and treatment. Am Fam Physician 2000;62(11):2485–2490.
  2. Het Acute Boekje. Endocrinology, myxedema coma – hypothyroid crisis. Available at www.hetacuteboekje.nl (accessed 15 June 2020).
  3. Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, et al. A diagnostic scoring system for myxedema coma. Endocr Pract 2014;20(8):808–817. doi: 10.4158/ep13460.or
  4. Arlot S, Debussche X, Lalau JD, Mesmacque A, Tolani M, Quichaud J, et al. Myxoedema coma: response of thyroid hormones with oral and intravenous high-dose L-thyroxine treatment. Intensive Care Med 1991;17(1):16–18. doi: 10.1007/BF01708403
  5. Charoensri S, Sriphrapradang C, Nimitphong H. Split high-dose oral levothyroxine treatment as a successful therapy option in myxedema coma. Clin Case Rep 2017;5(10):1706–1711. doi: 10.1002/ccr3.1131
  6. Rajendran A, Bhavani N, Nair V, Pavithran PV, Menon VU, Kumar H. Oral levothyroxine is an effective option for myxedema coma: a single-centre experience. Eur Thyroid J 2021;10:52–58. doi: 10.1159/000507855
  7. Papi G, Corsello SM, Pontecorvi A. Clinical concepts on thyroid emergencies. Front Endocrinol (Lausanne) 2014;5:102. doi: 10.3389/fendo.2014.00102
  8. Hylander, B, Rosenqvist U. Treatment of myxoedema coma – factors associated with fatal outcome. Acta Endocrinol (Copenh) 1985;108(1):65–71. doi: 10.1530/acta.0.1080065

Published

2021-10-08

Issue

Vol. 8 No. 9 (2021)

How to Cite

1.
Gadaen R, Tummers - de Lind van Wijngaarden R. Hypothyroid Crisis: Oral or Intravenous Treatment? A Report of Two Cases. EJCRIM [Internet]. 2021 Oct. 8 [cited 2026 Nov. 3];8(9). Available from: https://ejcrim.com/index.php/ejcrim/article/view/2752