{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:23:18Z","timestamp":1787840598534,"version":"build-2784847793"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:p>Myxedema coma is a rare condition and is associated with a high mortality rate. Management has been based on the medical experience due to its rarity. Here, we are presenting a case of a 78-year-old African American woman with Alzheimer\u2019s disease and primary hypothyroidism, who presented to the emergency department with altered sensorium, hypotension, severe hypothermia, and bradycardia. She was diagnosed with myxedema coma and admitted to the medical intensive care unit (ICU). Despite appropriate management, including early administration of intravenous thyroxine (FT4), the patient\u2019s hospital course was complicated. She went into multi-organ system failure, requiring multiple re-intubations due to the poor mental status. Although thyroid stimulating hormone (TSH) and T4 reached normal levels, there was no improvement in the patient\u2019s mental status which could be due to multiple factors including dementia at baseline, development of delirium and functional deconditioning later in her course. Myxedema Coma seen in elderly patients with dementia poses significant morbidity and mortality. Hence, a primary care physician or a geriatrician\u2019s role becomes crucial in maintaining proper follow-up of these patients to alleviate the above outcomes.<\/jats:p>","DOI":"10.4103\/jfmpc.jfmpc_1877_24","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T13:03:05Z","timestamp":1761742985000},"page":"4400-4403","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Clinical course of myxedema coma in an Alzheimer\u2019s disease patient and co-founding of J wave: A case report"],"prefix":"10.4103","volume":"14","author":[{"given":"Manar","family":"Shalak","sequence":"first","affiliation":[{"name":"Department of Medicine, Section of Geriatrics and Palliative Care, West Virginia University Health Sciences, West Virginia University, Morgantown, West Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsha Sai","family":"Sreemantula","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Geriatrics and Palliative Care, West Virginia University Health Sciences, West Virginia University, Morgantown, West Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eze","family":"Amaechi","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine and Critical Care, Lincoln Medical and Mental Health Center, NYC Hospitals, Bronx, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyedehferyal","family":"Mousavi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Lincoln Medical and Mental Health Center, NYC Hospitals, Bronx, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"R1-20251105","first-page":"2485","article-title":"Myxedema coma: Diagnosis and treatment","volume":"62","author":"Wall","year":"2000","journal-title":"Am Fam Physician"},{"key":"R2-20251105","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1507\/endocrj.EJ18-0469","article-title":"Successful treatment of myxedema coma with a combination of levothyroxine and liothyronine","volume":"66","author":"Ueda","year":"2019","journal-title":"Endocr J"},{"key":"R3-20251105","doi-asserted-by":"crossref","first-page":"7","DOI":"10.11604\/pamj.2019.34.7.19164","article-title":"Myxedema coma: Four patients diagnosed at the internal medicine department of the Dr. Negrin University hospital in Spain","volume":"34","author":"Villalba","year":"2019","journal-title":"Pan Afr Med J"},{"key":"R4-20251105","doi-asserted-by":"crossref","first-page":"315","DOI":"10.4103\/0019-5049.156889","article-title":"Myxoedema coma in adults: Experience from a tertiary referral hospital intensive care unit","volume":"59","author":"Murthy","year":"2015","journal-title":"Indian J Anaesth"},{"key":"R6-20251105","doi-asserted-by":"crossref","first-page":"365","DOI":"10.3389\/fphys.2016.00365","article-title":"Reduced sodium current in the lateral ventricular wall induces inferolateral J-Waves","volume":"7","author":"Meijborg","year":"2016","journal-title":"Front Physiol"},{"key":"R7-20251105","doi-asserted-by":"crossref","first-page":"969","DOI":"10.4103\/0366-6999.154320","article-title":"J wave syndromes: A decade of progress","volume":"128","author":"Li","year":"2015","journal-title":"Chin Med J (Engl)"},{"key":"R8-20251105","doi-asserted-by":"crossref","first-page":"bcr2015213411","DOI":"10.1136\/bcr-2015-213411","article-title":"Myxoedema coma in the setting of hyperglycaemic hyperosmolar state","author":"Spyridoulias","year":"2016","journal-title":"BMJ Case Rep 2016"},{"key":"R9-20251105","doi-asserted-by":"crossref","first-page":"bcr2014209071","DOI":"10.1136\/bcr-2014-209071","article-title":"Complete recovery after severe myxoedema coma complicated by status epilepticus","author":"Fj\u00f8lner","year":"2015","journal-title":"BMJ Case Rep 2015"},{"key":"R10-20251105","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.hrthm.2009.12.006","article-title":"J wave syndromes","volume":"7","author":"Antzelevitch","year":"2010","journal-title":"Heart Rhythm"},{"key":"R11-20251105","doi-asserted-by":"crossref","first-page":"434","DOI":"10.2310\/6650.2005.53807","article-title":"Osborn (J) wave appearance on the electrocardiogram in relation to potassium transfer and myocardial metabolism during hypothermia","volume":"53","author":"Brunson","year":"2005","journal-title":"J Investig Med"},{"key":"R12-20251105","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.acvd.2012.07.005","article-title":"Prevalence and prognostic significance of 'J waves'in patients experiencing ventricular fibrillation during acute coronary syndrome","volume":"105","author":"A\u00efssou","year":"2012","journal-title":"Arch Cardiovasc Dis"},{"key":"R13-20251105","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1111\/pace.12988","article-title":"Clinical significance of J Waves in patients undergoing therapeutic hypothermia for out-of-hospital cardiac arrest","volume":"40","author":"Harhash","year":"2017","journal-title":"Pacing Clin Electrophysiol"},{"key":"R14-20251105","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.resuscitation.2018.04.037","article-title":"Osborn waves following out-of-hospital cardiac arrest-effect of level of temperature management and risk of arrhythmia and death","volume":"128","author":"Hadziselimovic","year":"2018","journal-title":"Resuscitation"},{"key":"R15-20251105","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.ajem.2018.08.049","article-title":"Osborn wave in hypothermia and relation to mortality","volume":"37","author":"Eroglu","year":"2019","journal-title":"Am J Emerg Med"},{"key":"R16-20251105","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1253\/circj.CJ-19-0856","article-title":"Osborn wave is related to ventricular fibrillation and tachycardia in hypothermic patients","volume":"84","author":"Okada","year":"2020","journal-title":"Circ J"},{"key":"R17-20251105","doi-asserted-by":"crossref","first-page":"e828","DOI":"10.1002\/ams2.828","article-title":"Successfully treated case of severe hypothermia secondary to myxedema coma","volume":"10","author":"Yamamoto","year":"2023","journal-title":"Acute Med Surg"},{"key":"R18-20251105","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1507\/endocrj.EJ21-0720","article-title":"A case of fatal myxedema coma with electrocardiogram Osborne J-wave in a patient initially diagnosed with hypothyroidism","volume":"69","author":"Kaneko","year":"2022","journal-title":"Endocr J"},{"key":"R19-20251105","first-page":"171","article-title":"Myxedema coma patient in emergency department: A case report","volume":"7","author":"Han","year":"2017","journal-title":"J Acute Med"},{"key":"R20-20251105","first-page":"2713","article-title":"Myxedema psychosis: Systematic review and pooled analysis","volume":"17","author":"Mohamed","year":"2021","journal-title":"Neuropsychiatr Dis Treat"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1877_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:25:41Z","timestamp":1787837141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1877_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":19,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1877_24","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2024-11-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}