Visual Hallucinations in a Patient with Myxedema Coma

Abstract

Myxedema coma is a rare endocrine complication of hypothyroidism. Infections and cardiovascular diseases are the most common precipitants. Rarely, visual hallucinations are seen as part of the disease process, as they are more commonly caused by other psychiatric, pathological, metabolic, or hormonal disorders. We report a 72-year-old Caucasian male was brought to emergency room for rapid onset of weight gain, bilateral lower extremity edema, and visual hallucinations for a week. His past medical history was significant for with medical history of hypothyroidism, coronary artery disease status post one stent, essential hypertension, right renal cell carcinoma status post nephrectomy on chemotherapy, and chronic kidney disease stage 4. Initial laboratory results revealed hyponatremia, elevated liver enzymes, elevated thyroid stimulating hormone, low free thyroxine. A diagnosis of myxedema coma was established. He received thyroxine, mineralocorticoid supplement, hypertonic intravenous fluid, and intensive supportive care. Suspicion of myxedema coma should be treated without delay in order to avoid devastating outcomes.