A Case of Myxedema Coma Confounded by Dementia and Hypokalemia
Bibliographic record
Abstract
The hallmarks of myxedema coma are decreased mental status and hypothermia; but hypotension, bradycardia, hyponatremia, hypoglycemia, and hypoventilation may also be present. This case involves a 74-year-old female, with arthritis and dementia, who presented with weakness and failure to thrive. Physical exam was significant for altered level of consciousness, lethargy, pretibial pitting edema and hypotension. Since friends and family were absent, history was obtained per chart review. Initial labs showed severe hypokalemia of 2.0 mmol/L and associated changes of prolonged QT interval and T wave flattening on electrocardiogram (ECG). The family later revealed additional history of thyroidectomy and clarification that the patient had been noncompliant with her medications for at least 6 months. Hypothyroidism was confirmed with a thyroid stimulating hormone (TSH) level of 82.2 U/mL and a free thyroxine (T4) level below normal threshold. Endocrinology was consulted and care was taken when reinstituting her thyroid supplementation after checking cortisol level as well as reviewing her ECGs. This case report illustrates the importance of checking for thyroid dysfunction especially in the elderly who present with altered mental status and unclear history as most symptoms of myxedema coma may be reversible. Furthermore, myxedema coma occurring in the setting of decompensated hypothyroidism is a medical emergency. In this case, despite timely diagnosis and appropriate treatment, her cognitive function failed to improve, and as a result, palliative care was consulted. Ultimately, the family elected for hospice care due to severe dementia, bed-bound status, and failure to thrive. J Endocrinol Metab. 2019;9(3):71-76 doi: https://doi.org/10.14740/jem574
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".