امرأة عمرها ٨٢ سنة عندها قصور درقية، أوقفت دواءها منذ شهور. جاءت في الشتاء نعسانة جداً وصعبة الإيقاظ، والحرارة ٣٤٫٦، والنبض ٤٤، والضغط ٨٦/٥٠، والتنفس ٨، والصوديوم ١٢٤، والوجه منتفخ. ما الحالة؟

An 82-year-old woman with hypothyroidism stopped her medicine months ago. In winter she presents very drowsy and hard to rouse, T 34.6 °C, HR 44, BP 86/50, RR 8, sodium 124, with a puffy face. What is the condition?

1. Sedative poisoning from household medicines
2. A stroke with hypothermia
3. Myxoedema coma (severe hypothyroidism)
4. Hypoglycaemia from poor intake only

Answer: C) Myxoedema coma (severe hypothyroidism). Severe untreated hypothyroidism can cause coma with hypothermia, bradycardia, hypoventilation and hyponatraemia. It needs ICU care, IV thyroxine, steroids, gradual rewarming and ventilatory support.