An observational study analyzing 12 adult patients (median age 66, 50% female) diagnosed with myxedema coma at a tertiary center between 2011 and 2021 highlights the efficacy of high-dose oral levothyroxine as a viable treatment, particularly when the intravenous formulation is unavailable. Diagnosis was established using Popoveniuc criteria or the presence of coma with hypothyroidism, with acute infection being the most common trigger (41.6%).

All patients received an oral loading dose (median 500 μg) followed by high-dose maintenance therapy, leading to rapid biochemical recovery, with free T4 levels normalizing in every patient by the fourth day.

Despite this successful early recovery, myxedema crisis remains a severe condition requiring aggressive support. All patients required ICU admission (median stay of 11 days), and 58.3% needed vasopressor support. The in-hospital mortality rate for this critically ill cohort was 25%.

The findings suggest that high-dose oral levothyroxine is an effective and potentially life-saving alternative for achieving early biochemical normalization in myxedema coma, validating its use as a crucial supportive therapy in such critical settings.

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