{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T08:45:20Z","timestamp":1762677920976,"version":"build-2065373602"},"reference-count":15,"publisher":"The Endocrine Society","issue":"12","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Myxedema coma is a rare but serious complication of severe hypothyroidism, often presenting without coma, complicating diagnosis. Cardiovascular and hematologic abnormalities can predominate, including pericardial effusion and bleeding diathesis. We describe a 38-year-old woman with no thyroid history who presented with significant menorrhagia and acute anemia. She had fatigue, cold intolerance, and intermittent bradycardia but no hypothermia or altered mental status. Evaluation revealed a prolonged activated partial thromboplastin time and a large pericardial effusion with early tamponade, requiring pericardiocentesis. Thyroid testing showed profound hypothyroidism. Her presentation suggested myxedema coma despite preserved consciousness. She was treated with intravenous levothyroxine, hydrocortisone, red blood cell transfusion, and progestin therapy, resulting in complete resolution of the effusion and stabilization of hemoglobin. She remained asymptomatic on oral levothyroxine at 2-month follow-up. This case highlights an unusual presentation of new-onset hypothyroidism manifesting as menorrhagia with coagulopathy and pericardial effusion. The reversible nature of both the hematologic and cardiovascular findings underscores the importance of early recognition and treatment. Clinicians should consider thyroid dysfunction in unexplained heavy menstrual bleeding or severe anemia, particularly when systemic features suggest endocrine involvement.<\/jats:p>","DOI":"10.1210\/jcemcr\/luaf257","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T08:42:02Z","timestamp":1762677722000},"source":"Crossref","is-referenced-by-count":0,"title":["Severe Menorrhagia as the Initial Presentation of Myxedema Coma With Pericardial Effusion"],"prefix":"10.1210","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8180-0741","authenticated-orcid":false,"given":"Carlos Andres","family":"Penaherrera","sequence":"first","affiliation":[{"name":"Hamilton Diabetes and Endocrinology Center, Vitruvian Health System , Dalton 30720 ,","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aseel","family":"Abualnil","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hamilton Medical Center, Vitruvian Health System , Dalton 30720 ,","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline S","family":"Martins Torrontegui","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hamilton Medical Center, Vitruvian Health System , Dalton 30720 ,","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Punerdeep Singh","family":"Sidhu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hamilton Medical Center, Vitruvian Health System , Dalton 30720 ,","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Hamad","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hamilton Medical Center, Vitruvian Health System , Dalton 30720 ,","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ami","family":"Bhalodia","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hamilton Medical Center, Vitruvian Health System , Dalton 30720 ,","place":["Georgia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"issue":"1","key":"2025110903415862800_luaf257-B1","first-page":"493462","article-title":"Myxedema coma: a new Look into an old crisis","volume":"2011","author":"Mathew","year":"2011","journal-title":"J Thyroid Res"},{"issue":"8","key":"2025110903415862800_luaf257-B2","doi-asserted-by":"crossref","first-page":"808","DOI":"10.4158\/EP13460.OR","article-title":"A diagnostic scoring system for myxedema coma","volume":"20","author":"Popoveniuc","year":"2014","journal-title":"Endocr Pract"},{"issue":"4","key":"2025110903415862800_luaf257-B3","first-page":"419","article-title":"Clinical features and outcomes of myxedema coma in patients hospitalized for hypothyroidism: analysis of the United States national inpatient 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hearing loss: a case report","volume":"19","author":"Seo","year":"2019","journal-title":"BMC Endocr Disord"},{"issue":"2 Pt 2","key":"2025110903415862800_luaf257-B7","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/01.AOG.0000275285.04825.07","article-title":"Profound hypothyroidism-induced acute menorrhagia resulting in life-threatening anemia","volume":"110","author":"Moragianni","year":"2007","journal-title":"Obstet Gynecol"},{"issue":"1","key":"2025110903415862800_luaf257-B8","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1186\/s13052-022-01363-x","article-title":"Menorrhagia as main presentation sign of severe hypothyroidism in a pediatric patient: a case report","volume":"48","author":"Barbero","year":"2022","journal-title":"Ital J Pediatr"},{"issue":"2","key":"2025110903415862800_luaf257-B9","first-page":"e42649","article-title":"Hemostasis in hypothyroidism and Autoimmune Thyroid Disorders","volume":"15","author":"Ordookhani","year":"2017","journal-title":"Int J Endocrinol Metab"},{"issue":"2","key":"2025110903415862800_luaf257-B10","doi-asserted-by":"crossref","first-page":"268","DOI":"10.4103\/ijem.IJEM_120_19","article-title":"Myxedema Coma. Pancytopenia, and Hypocoagulopathy: a rare presentation of Sheehan's Syndrome","volume":"23","author":"Mylliemngap","year":"2019","journal-title":"Indian J Endocrinol Metab"},{"issue":"6","key":"2025110903415862800_luaf257-B11","first-page":"e62961","article-title":"A case of myxedema edema in a patient with factors XI and XII deficiency and sepsis: unveiling complications and management strategies","volume":"16","author":"Montecinos","year":"2024","journal-title":"Cureus"},{"issue":"3","key":"2025110903415862800_luaf257-B12","first-page":"47","article-title":"The role of von Willebrand factor alterations in thyroid disorders","volume":"7","author":"Kyriazi","year":"2020","journal-title":"J Basic Res Med Sci"},{"issue":"1","key":"2025110903415862800_luaf257-B13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1055\/s-0030-1270065","article-title":"The spectrum of coagulation abnormalities in thyroid disorders","volume":"37","author":"Vescovi","year":"2011","journal-title":"Semin Thromb Hemost"},{"issue":"4","key":"2025110903415862800_luaf257-B14","first-page":"321","article-title":"Myxedema coma","volume":"77","author":"Rizzo","year":"2017","journal-title":"Medicina (Mex)"},{"issue":"4","key":"2025110903415862800_luaf257-B15","first-page":"e23881","article-title":"New-Onset hypothyroidism manifesting as myxedema coma: fighting an old enemy","volume":"14","author":"Santos Argueta","year":"2022","journal-title":"Cureus"}],"container-title":["JCEM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/3\/12\/luaf257\/65239990\/luaf257.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/3\/12\/luaf257\/65239990\/luaf257.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T08:42:05Z","timestamp":1762677725000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcemcr\/article\/doi\/10.1210\/jcemcr\/luaf257\/8316639"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,27]]},"references-count":15,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,10,27]]}},"URL":"https:\/\/doi.org\/10.1210\/jcemcr\/luaf257","relation":{},"ISSN":["2755-1520"],"issn-type":[{"value":"2755-1520","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,10,27]]},"article-number":"luaf257"}}