Myxedema Coma Diagnostic Score

The myxedema coma diagnostic score (Popoveniuc and colleagues 2014), the hypothyroid counterpart to the two thyroid-storm tools on this site.

Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.

Example

Thermoregulatory dysfunction
Above 35 degrees C (above 95 F)
Central nervous system effects
Absent
Gastrointestinal findings
Absent
Precipitating event
Yes
Bradycardia
Absent
Other ECG changes
No
Pericardial or pleural effusion
No
Pulmonary edema
No
Cardiomegaly
No
Hypotension
No
The other 5 values
Hyponatremia
Yes
Hypoglycemia
Yes
Hypoxemia
Yes
Hypercarbia
Yes
Decrease in glomerular filtration rate
Yes

Result: 60

The tool opens with these values already filled in. Replace them with your own.

What the result means

60 or more
Highly suggestive / diagnostic of myxedema coma. AGREED across renderings.
45 to 59
At risk / supportive - both renderings agree here.
25 to 44
RENDERINGS DISAGREE: the adapted table calls this supportive, the primary abstract calls it below its at-risk band.
Under 25
Myxedema coma unlikely (adapted table).
Ladders
Temperature, CNS, GI and bradycardia are SINGLE-PICK. One option each.
Additive
The five cardiovascular items and all five metabolic items ADD INDEPENDENTLY. The CV block alone can reach 100 - more than the threshold.
Scale
Maximum 230. The threshold of 60 is only about a QUARTER of it - it sounds higher than it is.
Specificity
The 5 metabolic items total 50 and NONE is specific to hypothyroidism. Those five plus a precipitating event total EXACTLY 60.
Cohort
Derived in TWENTY-ONE patients (14 cases, 7 controls). The 100%/85.7% figures are fragile.
Scope
A diagnostic aid for a CLINICAL diagnosis. Does not dose thyroid hormone or steroids. Below threshold does NOT exclude it.

What you enter

  • Thermoregulatory dysfunction.
  • Central nervous system effects.
  • Gastrointestinal findings.
  • Precipitating event.
  • Bradycardia.
  • Other ECG changes (QT prolongation, low voltage, bundle branch block, non-specific ST-T changes, or heart block).
  • Pericardial or pleural effusion.
  • Pulmonary edema.
  • Cardiomegaly.
  • Hypotension.
The other 5 fields
  • Thermoregulatory dysfunction. A LADDER - one option only [above-35 = Above 35 degrees C (above 95 F) (0); 32-35 = 32 to 35 degrees C (89.6 to 95 F) (10); below-32 = Below 32 degrees C (below 89.6 F) (20)]
  • Central nervous system effects. A LADDER - one option only [absent = Absent (0); somnolent = Somnolent or lethargic (10); obtunded = Obtunded (15); stupor = Stupor (20); coma-seizures = Coma or seizures (30)]
  • Gastrointestinal findings. A LADDER - one option only [absent = Absent (0); anorexia = Anorexia, abdominal pain or constipation (5); decreased-motility = Decreased intestinal motility (15); paralytic-ileus = Paralytic ileus (20)]
  • Precipitating event. Adds 10.
  • Bradycardia. A LADDER - one option only - but it ADDS TO the five independent cardiovascular items [absent = Absent (0); 50-59 = Heart rate 50 to 59 (10); 40-49 = Heart rate 40 to 49 (20); below-40 = Heart rate below 40 (30)]
  • Other ECG changes (QT prolongation, low voltage, bundle branch block, non-specific ST-T changes, or heart block). ADDS 10 INDEPENDENTLY - this is not a ladder option.
  • Pericardial or pleural effusion. ADDS 10 INDEPENDENTLY - this is not a ladder option.
  • Pulmonary edema. ADDS 15 INDEPENDENTLY - this is not a ladder option.
  • Cardiomegaly. ADDS 15 INDEPENDENTLY - this is not a ladder option.
  • Hypotension. ADDS 20 INDEPENDENTLY - this is not a ladder option.
  • Hyponatremia. ADDS 10 INDEPENDENTLY. NOT specific to hypothyroidism - all five together total 50.
  • Hypoglycemia. ADDS 10 INDEPENDENTLY. NOT specific to hypothyroidism - all five together total 50.
  • Hypoxemia. ADDS 10 INDEPENDENTLY. NOT specific to hypothyroidism - all five together total 50.
  • Hypercarbia. ADDS 10 INDEPENDENTLY. NOT specific to hypothyroidism - all five together total 50.
  • Decrease in glomerular filtration rate. ADDS 10 INDEPENDENTLY. NOT specific to hypothyroidism - all five together total 50.
How this is calculated

Popoveniuc G, Chandra T, Sud A, et al. A diagnostic scoring system for myxedema coma. Endocr Pract. 2014;20(8):808-817. Read the source ↗

A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.

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Built by Clay Good. Source on GitHub.