Endocrinology: myxoedema coma: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology: myxoedema coma

Sample item

A 75-year-old woman with known hypothyroidism is found in winter with hypothermia, bradycardia, hypoventilation and sodium of 118 mmol/L. What is the best treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous levothyroxine with intravenous hydrocortisone

Myxoedema coma is a life-threatening decompensation of hypothyroidism, and treatment is intravenous thyroid hormone with hydrocortisone to cover possible adrenal insufficiency. Supportive care includes ventilation, passive rewarming and cautious fluids. Active rewarming can cause vasodilatation and shock.

Option by option

  • A. Oral triiodothyronine alone

    Oral T3 alone does not cover adrenal insufficiency and is not enough.

  • B. Intravenous levothyroxine with intravenous hydrocortisone (correct)

    Correct. IV thyroxine plus hydrocortisone is the standard.

  • C. Rapid external rewarming with a hot bath

    Rapid active rewarming risks vascular collapse.

  • D. Low-dose oral levothyroxine alone

    Oral drug is poorly absorbed and too slow in a comatose patient.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Intravenous levothyroxine with intravenous hydrocortisone. Myxoedema coma is a life-threatening decompensation of hypothyroidism, and treatment is intravenous thyroid hormone with hydrocortisone to cover possible adrenal insufficiency.

Why is "Oral triiodothyronine alone" not the answer?

Oral T3 alone does not cover adrenal insufficiency and is not enough.

Why is "Rapid external rewarming with a hot bath" not the answer?

Rapid active rewarming risks vascular collapse.

Why is "Low-dose oral levothyroxine alone" not the answer?

Oral drug is poorly absorbed and too slow in a comatose patient.

What concept does this question test?

It tests Endocrinology: myxoedema coma in General Medicine. Supportive care includes ventilation, passive rewarming and cautious fluids. Active rewarming can cause vasodilatation and shock.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: myxoedema coma?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.