Archana Purushothaman

Myxedema coma is a critical endocrine condition with a high risk of death, caused by severe, long-term hypothyroidism and the failure of the body's normal mechanisms to maintain internal balance. Intravenous LT4 thyroid hormone replacement, combined with supportive care, is essential for the prompt recovery of neurological, cardiovascular, renal, pulmonary, and metabolic dysfunction. Coexisting comorbidities can affect the intensity of hormone replacement therapy and must be closely monitored during treatment. We present the case of a 48-year-old male who arrived at the emergency room unresponsive, with bradycardia, hypoxia, hypotension, found to have a complete heart block from inferior wall myocardial infarction. Initial treatment prioritized his cardiac resuscitation but , further investigation revealed severe hypothyroidism. The patient was started on levothyroxine, (oral followed by IV ) parallel to the intricate management of complications including cardiomyopathy, shock liver, acute kidney injury and diabetes with gradual improvement in mental status and hemodynamics over a course of a week. This case underscores the importance of recognizing hypothyroidism as a critical etiology in patients presenting with multi-organ failure and the role of Levothyroxine in cardiac function.