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J Pediatr Intensive Care 2020; 09(01): 070-073
DOI: 10.1055/s-0039-1698812
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Myxedema Coma in a Pediatric Patient with Down Syndrome

Chhaya A. Divecha
1   College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
,
Milind S. Tullu 
2   Department of Pediatrics, Pediatric Intensive Care Unit, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
,
Chandrahas T. Deshmukh
2   Department of Pediatrics, Pediatric Intensive Care Unit, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
,
Sunil Karande
2   Department of Pediatrics, Pediatric Intensive Care Unit, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
› Author Affiliations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Further Information

Publication History

07 August 2019

12 September 2019

Publication Date:
24 October 2019 (online)

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Abstract

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.

Keywords

altered mental status - Down syndrome - hypothyroidism - PICU - myxedema coma

Authors' Contributions

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.


Note

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.