Jornal de Distúrbios e Terapia da Tireóide
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Sequential Thyroid Storm and Myxedema Coma: A Unique Case Report

Eiman Alseddeeqi, Natasha Garfield and Jacques How

Background and objective: Both thyroid storm and myxedema coma are rare life-threatening events and carry a high mortality rate. Our objective is to document a unique case of sequential thyroid storm and myxedema coma.

Results: We report a very unusual case of a 46-year-old female patient who presented initially in 2002 with thyroid storm caused by a previously undiagnosed Graves’ disease. After two doses of radioactive iodine treatment, she developed hypothyroidism for which she was placed on l-thyroxine replacement therapy. She was lost to followup and, indeed, she failed to take her l-thyroxine medication and in the fall of 2010, she presented to our Emergency Department with myxedema coma, which was treated successfully.

Conclusion: A careful and life-long follow-up is essential in patients who have received thyroid radioactive iodine ablation or total thyroidectomy to ensure that their thyroidal status remains stable. This constitutes the first step in the prevention of myxedema coma, a diagnosis which still carries an appreciable mortality rate.