What is the pathogenesis of myxedema coma (crisis)?

Updated: Oct 10, 2018
  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

Myxedema coma occurs as a result of long-standing, undiagnosed, or undertreated hypothyroidism and is usually precipitated by a systemic illness. Myxedema coma can result from any of the causes of hypothyroidism, most commonly chronic autoimmune thyroiditis. It can also occur in patients who had thyroidectomy or underwent radioactive iodine therapy for hyperthyroidism. Rare causes may include secondary hypothyroidism and medications such as lithium and amiodarone. [3, 4]

Given the importance of thyroid hormones in cell metabolism, long-standing hypothyroidism is associated with reduced metabolic rate and decreased oxygen consumption, which affects all body systems. [5]  This results in hypothermia, which is a strong predictor of mortality. Another consequence is decreased drug metabolism leading to overdosing of medications particularly sedatives, hypnotics, and anesthetic agents; this can precipitate myxedema coma.


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