Undiagnosed Hypothyroidism in Pregnancy Leading to Myxedema Coma in labor: Diagnosing and managing this rare Emergency

Myxedema crisis is an extreme complication of uncontrolled hypothyroidism. It is usually seen in elderly women with undiagnosed hypothyroidism and is rare among young. There have been very few reports of myxedema coma in labor. This report pertains to a case of undiagnosed hypothyroidism in a 30 year old lady with twin pregnancy which led to hypothyroidism crisis during labor. Levothyroxine 100 microgram was given by Ryle’s tube followed by 8 hourly doses till total dose of 900 microgram. Rapid and robust correction of hypothyroidism led to successful treatment outcome. Treatment requires a rapidly administered oral or parenteral loading dose and high maintenance doses of levothyroxine. She delivered vaginally and both the babies were fine. Maintenance dose of 100 ugm of levothyroxine was started and patient was discharged after 15 days of delivery with an advice of 100 micrograms of levothyroxine daily.