Which therapy is central to treating myxedema coma?

• A. IV thyroid hormone (levothyroxine) and supportive care
• B. Oral thyroid hormone
• C. PTU
• D. High-dose hydrocortisone alone

Answer: (A)

The central concept is that myxedema coma requires rapid and reliable thyroid hormone replacement to reverse the profound hypothyroidism driving the crisis. In a comatose, critically ill patient, oral levothyroxine is unreliable because gut absorption can be severely impaired, so giving thyroid hormone intravenously ensures a prompt and consistent rise in thyroid hormone levels and metabolic activity. This immediate replacement, typically IV levothyroxine (with dosing adjusted for severity and sometimes combined with IV T3 in the most ill patients), is the mainstay of treatment.

Supportive care is essential alongside this replacement: securing the airway and providing ventilation if needed, rewarming, careful fluid and electrolyte management, glucose control, and treating any precipitating factors such as infection. Hydrocortisone is added empirically if adrenal insufficiency is a concern, because the two conditions can coexist and you don’t want to miss an adrenal crisis, but it does not correct the underlying hypothyroid state by itself. The other options don’t address the primary, urgent need to restore thyroid hormone activity in this crisis.