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)

Conclusions

We report, to our knowledge, the first case of MC with SARS-CoV-2 infection complicated by sudden cardiac arrest. We discuss how SARS-CoV-2 may have precipitated multiorgan damage and SCA in our patient (Figure 1). Further studies are needed to elucidate the direct effects of SARS-CoV-2 infection on heart and thyroid tissues. We suggest prompt treatment of MC with conservative doses of IV levothyroxine for patients with preexisting cardiovascular disease or in acute illnesses known to cause cardiac damage such as COVID-19.

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Abbreviations
ACE2, angiotensin-converting enzyme 2; COVID-19, coronavirus disease 2019; IV, intravenous; MC, myxedema coma; PEA, pulseless electrical activity; RBBB, right bundle branch block;RV, right ventricular;SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; SCA, sudden cardiac arrest; SCLC, small cell lung cancer; T₃, 3,5,3'-triiodothyronine; T₄, thyroxine; TSH, thyrotropin.

Acknowledgments
Financial Support
The authors received no financial support for the research, authorship, and/or publication of this article.

Additional Information
Data Availability
Data sharing is not applicable to this article because no data sets were generated or analyzed during the present study.

Table 1. Pertinent laboratory findings on admission
	Laboratory value	Reference range
White blood cell count, cells/μL	22 × 10E3	4.16–9.95 × 10E3
Absolute lymphocyte count, cells/μL	0.64 × 10E3	1.3–3.4 × 10E3
Hemoglobin, g/dL	10.7	11.6–15.2
Sodium, mmol/L	151	135–146
Potassium, mmol/L	4.0	3.6–5.3
Bicarbonate, mmol/L	20	20–30
Calcium, mg/dL	8.1	8.6–10.4
Serum creatinine, mg/dL	1.80	0.6–1.3
TSH, μU/mL	61.3	0.3–4.7
Free T₄, ng/dL	0.2	0.8–1.7
Free T₃, pg/dL	66	222–387
Total T₃, ng/dL	26	85–185
Thyroid peroxidase antibody, IU/mL	33.4	≤ 20
Cortisola, mcg/dL	49	> ~10
Lactate, mg/dL	55	5–25
Troponin, ng/mL	0.14	< 0.1
Creatinine kinase, U/L	1908	38–282
IL-6, pg/mL	21	≤ 5
D-dimer, ng/mL	> 10 000	≤ 499
Ferritin, ng/mL	4759	8–180
Lactate dehydrogenase, U/L	614	125–256
C-reactive protein, mg/dL	13.8	< 0.8

Abbreviations: IL-6, interleukin-6; T₃, 3,5,3'-triiodothyronine; T₄, thyroxine; TSH, thyrotropin.
^aCollected prior to hydrocortisone replacement at 19:44 h.

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

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