Myxedema Coma in a Pediatric Patient with Down SyndromeFunding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
07 August 2019
12 September 2019
24 October 2019 (online)
Myxedema coma due to severe/long standing hypothyroidism is a known fatal endocrine emergency but is rare in children and unreported in pediatric Down syndrome. It mimics other conditions in the emergency room, making the diagnosis challenging. We present a 10-year-old-male child with global developmental delay and Down syndrome phenotype, admitted for altered sensorium subsequent to a febrile illness. The presence of myxedematous changes on clinical examination, on a background of altered sensorium and hypothermia, led to suspicion of myxedema coma, confirmed by laboratory testing. Due to nonavailability of triiodothyronine (T3), thyroxine (T4) was administered through nasogastric tube after an endocrine consult. Despite initial recovery in terms of improved consciousness, the child ultimately succumbed to refractory shock and terminal ventricular tachycardia. Our case highlights the need to consider myxedema coma as a differential diagnosis for altered mental status in the emergency room and use of screening tools for effective selection of patients.
C.D. and M.S.T. were involved in conceptualizing the manuscript, collecting patient data, conducting literature search, and drafting the manuscript. Both C.D. and M.S.T. are designated as first authors of the manuscript. C.T.D. and S.K. supervised the data collection, helped in literature search, and revised the manuscript for scientific content. All the authors were involved in the clinical management of the patient. M.S.T. will act as the guarantor of the paper.
This case was presented as a poster at the 9th Congress of the World Federation of Pediatric Intensive & Critical Care Societies at Singapore (9—13 June 2018) and a similar abstract (PCCLB-14) has been published in the journal Pediatric Critical Care Medicine (year 2018; volume 19; number 6 [Suppl.]), as a part of the proceedings of the said conference.
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