Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19

Neal M. Dixit; Katie P. Truong; Soniya V. Rabadia; David Li; Pratyaksh K. Srivastava; Tina Mosaferi; Marcella A. Calfon Press; Ines Donangelo; Theodoros Kelesidis

Disclosures

J Endo Soc. 2020;4(10) 

In This Article

Abstract and Introduction

Abstract

SARS-CoV-2 infection is associated with significant lung and cardiac morbidity but there is a limited understanding of the endocrine manifestations of coronavirus disease 2019 (COVID-19). Although thyrotoxicosis due to subacute thyroiditis has been reported in COVID-19, it is unknown whether SARS-CoV-2 infection can also lead to decompensated hypothyroidism. We present the first case of myxedema coma (MC) in COVID-19 and we discuss how SARS-CoV-2 may have precipitated multiorgan damage and sudden cardiac arrest in our patient.

A 69-year-old woman with a history of small cell lung cancer presented with hypothermia, hypotension, decreased respiratory rate, and a Glasgow Coma Scale score of 5. The patient was intubated and administered vasopressors. Laboratory investigation showed elevated thyrotropin, very low free thyroxine, elevated thyroid peroxidase antibody, and markedly elevated inflammatory markers. SARS-CoV-2 test was positive. Computed tomography showed pulmonary embolism and peripheral ground-glass opacities in the lungs. The patient was diagnosed with myxedema coma with concomitant COVID-19. While treatment with intravenous hydrocortisone and levothyroxine were begun the patient developed a junctional escape rhythm. Eight minutes later, the patient became pulseless and was eventually resuscitated. Echocardiogram following the arrest showed evidence of right heart dysfunction. She died 2 days later of multiorgan failure. This is the first report of SARS-CoV-2 infection with MC. Sudden cardiac arrest likely resulted from the presence of viral pneumonia, cardiac arrhythmia, pulmonary emboli, and MC—all of which were associated with the patient's SARS-CoV-2 infection.

Introduction

There is a limited understanding of the endocrine manifestations of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).[1] Thyrotoxicosis has been reported in 3 cases of subacute thyroiditis in coronavirus disease 2019 (COVID-19).[2–4] To our knowledge, there have been no cases of decompensated hypothyroidism in the setting of COVID-19. Myxedema coma (MC) is a rare presentation of decompensated hypothyroidism often precipitated by infection.[5] We present the first case of MC in COVID-19. We discuss how SARS-CoV-2 infection may have precipitated multiorgan damage and sudden cardiac arrest in the setting of MC.

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