Most patients have neither non-pitting oedema known as myxoedema nor coma. The cardinal sign is a deterioration of the patient's mental status from baseline and it is a differential of delirium. Physicians should be alert for myxoedema coma, particularly in elderly women with mental status changes who present during the winter months
The issue of whether myxoedema coma should be treated with LT4 alone or a combination of LT4 plus LT3 is controversial and doses vary between experts. Sometimes they are combined. The available case series suggest higher mortality with initial T4 doses larger than 500 mcg and with T3 doses larger than 75 mcg daily.
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Myxoedema coma
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