Registered Nurse (RN) Endocrine Licensure Exam

Which patient is at highest risk for developing myxedema coma?

1. A 28 year old female prescribed Methimazole

2. A 75 year old female taking Lithium and missing doses of Synthroid

3. A 69 year old male experiencing nausea and vomiting

4. A 55 year old male with insulin-dependent diabetes

The correct answer is: A 75 year old female taking Lithium and missing doses of Synthroid

The patient most at risk for developing myxedema coma is the 75-year-old female taking Lithium and missing doses of Synthroid. Myxedema coma is a severe form of hypothyroidism that can be life-threatening, typically characterized by inadequate thyroid hormone levels, which can be exacerbated by factors such as advanced age, medication noncompliance, and other comorbidities. In this scenario, the 75-year-old woman is already on Synthroid, a thyroid hormone replacement therapy, which indicates she has a history of hypothyroidism. Missing doses of Synthroid can lead to dangerously low levels of thyroid hormone in the body, particularly in older adults who may have altered metabolic demands and are less able to compensate for missed doses. Additionally, the use of Lithium, which can interfere with thyroid function, increases her risk for developing severe hypothyroidism, thus making her a prime candidate for myxedema coma. Overall, the combination of advanced age, the presence of a chronic condition, medication noncompliance, and the influence of a drug that can impair thyroid function contributes to her being at the highest risk compared to the other patients listed.