Myxedema Coma Precipitated by Diabetic Ketoacidosis

Abstract

Objective:

To describe a rare case of myxedema coma with atypical presentation precipitated by diabetic ketoacidosis.

Methods:

The authors present a case report, including the detailed clinical and laboratory data, and review other significant reports available in the literature.

Results:

A 62-year-old woman with recent history of radioactive iodine therapy for Graves’ disease was admitted to the hospital for altered mental status and hyperglycemia. After treatment for diabetic ketoacidosis with intravenous fluid and insulin, hyperglycemia and ketonuria corrected, but her mental status remained profoundly compromised. Clinical conditions rapidly improved after initiation of treatment for myxedema coma with intravenous levothyroxine.

Conclusion:

This is a rare case of myxedema coma precipitated by diabetic ketoacidosis. Moreover, our case suggests that diabetic ketoacidosis can mask the typical clinical and laboratory features of myxedema coma, making the final diagnosis very challenging. Early recognition of an atypical presentation of myxedema coma is important to avoid the potential fatal outcome.