Vol 2:6 Answer

The Question
The answer is d
Myxedema coma is a life-threatening complication of hypothyroidism. Mortality in myxedema coma approaches 20% to 50% even with appropriate management. The patient exhibits classic signs and symptoms of the disease: lethargy or coma, hypothermia, bradycardia, periorbital and nonpitting edema and delayed relaxation phase of deep tendon reflexes (areflexia in more severe cases). Myxedema coma can be triggered by sepsis, trauma, surgery, congestive heart failure, prolonged cold exposure or use of sedatives or narcotics.

(a) The patient is actually hyperglycemic. Abnormal reflexes, hypothermia and periorbital edema are inconsistent with the diagnosis of hypoglycemia as well as that of myocardial infarction (b). Stroke (c) should be on the differential in this case but the patient’s signs and symptoms are more consistent with abnormal metabolic state than with purely neurovascular change. Depression (e) is an often forgotten diagnosis in the elderly and may present with a wide variety of signs and symptoms. Severe depression may appear as lethargy. It is unlikely, however, to have associated hypothermia and abnormal reflexes.

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