What is the immediate treatment priority in myxedema coma?

• A. Start diuretics and antibiotics
• B. Secure airway, IV fluids, IV hydrocortisone, and thyroid hormone replacement
• C. Obtain MRI of the brain
• D. Administer salt tablets

Answer: (B)

The immediate priority in myxedema coma is rapid stabilization of the patient’s airway, breathing, and circulation, with specific steps to reverse the crisis. Securing the airway is crucial because altered mental status and hypoventilation are common, and without a protected airway the patient can deteriorate quickly. Alongside this, providing aggressive IV fluids supports circulating volume and tissue perfusion, which are often depressed in this state.

Because adrenal insufficiency can accompany severe hypothyroidism, starting IV hydrocortisone now helps cover that possibility even before cortisol results are back. This prevents a potentially dangerous adrenal crisis from complicating the course.

At the same time, thyroid hormone replacement should begin promptly to reverse the metabolic slowdown driving the coma. IV thyroid hormone, typically levothyroxine, is started to ensure rapid and reliable absorption and effect in the critically ill patient.

These actions take precedence over imaging or non-emergent measures. Antibiotics would be added if an infection is suspected, but they don’t address the immediate life-threatening stabilization needed in this crisis.