Challenging differential diagnosis, Rare disease
Emily Zagorski, Sahani Jayatilaka, Fizza Hirani, Anthony Donato
Department of Internal Medicine, Reading Hospital/Tower Health, Reading, PA, USA
Am J Case Rep 2020; 21:e926757
Available online: 2020-09-01
Myxedema coma is an uncommon severe thyroid disorder that is fatal in 25-60% of cases. Although the differential diagnosis for altered mental status is extensive, including many more common causes such as infection, medication changes, electrolyte abnormalities, and exacerbation of chronic illnesses, profound hypothyroidism is an uncommon cause that can be overlooked.
CASE REPORT: We describe the case of a 71-year-old man on long-term amiodarone treatment for atrial fibrillation who presented with altered mental status initially ascribed to uremia, hyponatremia, and pneumonia. When his mental status did not resolve, thyroid tests showed his thyroid-stimulating hormone level was 89 μIU/mL, along with clinical criteria for myxedema coma.
CONCLUSIONS: We suggest that thyroid function tests should be considered in encephalopathic older adults on amiodarone.
Keywords: Consciousness Disorders, Hypothyroidism, Myxedema, amiodarone, Drug-Related Side Effects and Adverse Reactions