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VOL. 11, ISSUE 2 (2026)
The "Alcoholic red herring": A case of myxedema encephalopathy masked by hyponatremia, chronic liver disease, and type 1 respiratory failure
Authors
Dr. Karthik R Rao, Dr. Supreeth Shetty, Dr. Shruthi Heggunje
Abstract
Altered mental status (AMS) in multi-morbid
elderly patients presents an intricate diagnostic challenge, often confounded
by overlapping clinical scenarios. We report a comprehensive case of a
63-year-old male with a background of daily alcohol consumption, hypertension,
and diabetes, who presented with an acute-on-chronic Chronic Obstructive
Pulmonary Disease (COPD) exacerbation manifest as Type 1 respiratory failure,
alongside profound neurocognitive delirium. Given the exceptionally low
clinical incidence of myxedema coma, primary diagnostic focus was initially
diverted toward more prevalent entities, including septic encephalopathy,
metabolic hyponatremia, and alcohol-related neurological pathologies
(Wernicke's encephalopathy or hepatic encephalopathy). While the respiratory
exacerbation was managed successfully with targeted antibiotics,
bronchodilators, and mucolytics, the patient's severe neurological deficit
remained critically out of proportion to his initial metabolic and infectious
indices. A subsequent diagnostic pivot and evaluation of the thyroid axis
revealed profound primary hypothyroidism with an undetectable Free T4 and a
severely elevated TSH. Following targeted hormonal replacement via a
nasogastric tube for three days and volume regulation via hypertonic saline,
the metabolic encephalopathy fully resolved. This report expands on the
physiological interdependencies between thyroid hormone failure and
respiratory/electrolyte homeostasis, highlighting the clinical imperative of
the "diagnostic pause" to avoid anchoring bias and diagnostic
overshadowing in multi-morbid patients.
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Pages:111-113
How to cite this article:
Dr. Karthik R Rao, Dr. Supreeth Shetty, Dr. Shruthi Heggunje "The "Alcoholic red herring": A case of myxedema encephalopathy masked by hyponatremia, chronic liver disease, and type 1 respiratory failure". International Journal of Advanced Scientific Research, Vol 11, Issue 2, 2026, Pages 111-113
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