Although the prognosis of patients with myxedema coma is difficult to determine, case series demonstrate consistently poor predictors of outcome, as reported in the literature, including bradycardia, persistent hypothermia, altered level of consciousness, a high APACHE II score at presentation, hypotension, need for mechanical ventilation, precipitation of myxedema coma by use of sedatives, accompanying sepsis, and baseline and mean SOFA scores greater than or equal to 6. Advanced age was not consistently reported as predictive of increased mortality in myxedema coma when survivors and nonsurvivors were compared.135,136
Patients who are stable, have mild symptoms that improve in the ED, and do not require continuous infusions of cardiovascularly active medications are candidates for admission to a telemetry unit. This is more commonly seen in thyroid storm because of the rapid effects of beta-blocking agents. Myxedema coma patients rarely have an accelerated recovery.
No formal admission or discharge criteria for those with mild to moderate thyroid disease have been reported to the author's knowledge. Patients with clinical signs and symptoms of hypothyroidism may be discharged from the ED for evaluation and treatment by the primary care physician. Patients with minor symptoms of hyperthyroidism, such as subjective palpitations, heat intolerance, anxiety, and weight loss, may be discharged if no signs of cardiac instability are present. Patients with tachycardias that respond to beta-blockers in the ED without other cardiovascular manifestations of thyrotoxicosis are also candidates for discharge from the ED. Patients with atrial fibrillation that is controlled in the ED who have a known diagnosis of hyperthyroidism may be candidates for discharge if appropriate follow-up can be arranged.