Myxedema Coma Awareness and Background for Pharmacists

BC Childress, PharmD, MBA, MOL, BCACP, FASCP, Director of Pharmacy, Owensboro Health System in Owensboro, KY, discusses the role of the pharmacist in treating myxedema coma.

BC Childress, PharmD, MBA, MOL, BCACP, FASCP: Myxedema coma is a critical condition that results from an imbalance in the thyroid hormones. Now, I've not been a critical care pharmacist myself, but in my years of management and health system pharmacy, I know that it's number one: time sensitive. There is a high mortality rate. We have to get to it quickly. [The] pharmacy [team] plays a big role in making sure that we determine the causes and help treat the imbalance of the thyroid hormones.

Pharmacists are positioned to treat and be a part of the treatment team in myxedema coma and really in 2 ways, and 1 begins at the admission medication reconciliation process, where your pharmacists are going to be best poised to identify any precipitating medications or contributing factors in that way. Once the patient is admitted, your pharmacists play an important role in helping determine what is the right dose of a thyroid hormone that we need to use—usually levothyroxine or the triiodothyronine—and it's going to be parenteral or by injection. Your pharmacy is going to be involved in helping make sure you've got the right dose, that is prepared appropriately and stored appropriately, and gets to the right patient at the right time.