Myxedema coma in a girl with untreated congenital hypothyroidism: case report
DOI:
https://doi.org/10.61651/rped.2019v71n2p23-27Keywords:
Myxedema, Congenital Hypothyroidism, ChildAbstract
Introduction: Congenital hypothyroidism is one of the most frequent preventable causes of mental retardation. At birth the signs and symptoms are nonspecific, that's why neonatal screening is important.
One of the most severe complications of untreated hypothyroidism is myxedema coma, a rare and lethal clinical condition in children, characterized by sensory disturbance, bradycardia, hypothermia, and hypotension.
Case report: A 12-year-old female patient with severe developmental delay was referred for sepsis with a urinary focus. On examination, size / age: -10.48 SD, weight / age: -10.15 SD, generalized edema, coarse facies, hoarse crying, dry skin, brittle hair. Her thyroid function: TSH> 100 uUI/ml and T4L <0.4 ng/dl. She attended with signs suggestive of surgical abdomen, requiring exploratory laparotomy, then presented severe bradycardia and hypotension that did not improve with inotropics and also required ventilatory support, being necessary to increase levothyroxine dose to 100mcg/d orally with improvement.
Comment: There is no consensus in children for the treatment of myxedema coma, only ventilatory support is suggested, regular body temperature and the pillar of the treatment is the hormonal replacement with levothyroxine intravenously, although in our case it was oral due to lack of availability in our country.
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