Which symptom profile best differentiates thyroid storm from myxedema coma?

• A. Thyroid storm presents with fever, tachycardia, agitation; myxedema coma presents with hypothermia and coma
• B. They present identically
• C. Thyroid storm presents with hypothermia
• D. Myxedema coma presents with fever and tachycardia

Answer: (A)

Thyroid hormones drive the body into a hypermetabolic state when in excess, whereas severe hypothyroidism pushes metabolism down to a very low level. In a thyroid storm, the excess hormones unleash heightened autonomic activity: the fever from increased thermogenesis, tachycardia from amplified adrenergic effects, and agitation or delirium from CNS stimulation. In contrast, myxedema coma reflects profound hypothyroidism and metabolic slowdown, so patients are typically hypothermic, with markedly reduced mental status progressing to coma, and often bradycardia and hypoventilation.

Therefore, a profile of fever, tachycardia, and agitation points to thyroid storm, while hypothermia with coma points to myxedema coma. This distinction helps distinguish the two crises clinically and guides appropriate management.