Which severe complication is associated with untreated hypothyroidism?

• A. Myxedema coma
• B. Hyperosmolar coma
• C. Seizure disorder
• D. Acute pancreatitis

Answer: (A)

Untreated hypothyroidism can progress to myxedema coma, a life-threatening state where body processes slow to a near halt. This severe complication presents with altered mental status or coma, very slowed or irregular breathing, extreme weakness, hypothermia, hypotension, bradycardia, hyponatremia, and often edema. It’s typically precipitated by another illness, cold exposure, or drugs that depress respiration or metabolism, and it requires urgent ICU care.

Management focuses on supporting vital functions and replacing thyroid hormone quickly. This means securing the airway and providing ventilation if needed, warming the patient, administering IV fluids, and giving thyroid hormone replacement (usually IV levothyroxine). Hydrocortisone is often given initially until adrenal insufficiency is ruled out, because adrenal crisis can mimic or accompany myxedema coma.

Hyperosmolar coma is related to severe dehydration from diabetes, not hypothyroidism. Seizure disorders can occur for many reasons but aren’t a hallmark complication of untreated hypothyroidism. Acute pancreatitis isn’t a typical or primary consequence of untreated hypothyroidism, though hypothyroid-related dyslipidemia is a separate risk factor for pancreatic issues in rare cases.