All are seen In myxedema coma except -

Myxedema coma is a very rare presentation of hypothyroidism usually in an elderly patient who appears myxedematous. It is a medical emergency and has a 20-40% moality rate, despite intensive treatment, and outcomes are independent of the T4 and TSH levels. Clinical manifestations include reduced level of consciousness, sometimes associated with seizures, as well as the other features of hypothyroidism including bradycardia, hypotension, dyspnoea etc. Hypothermia can reach 23degC (74degF). There may be a history of treated hypothyroidism with poor compliance, or the patient may be previously undiagnosed. It is usually precipitated by factors that impair respiration, such as drugs (especially sedatives, anesthetics, and antidepressants), pneumonia, congestive hea failure, myocardial infarction, gastrointestinal bleeding, or cerebrovascular accidents. Sepsis should also be suspected. Exposure to cold may also be a risk factor. Hypoventilation, leading to hypoxia and hypercapnia, plays a major role in pathogen- esis; hypoglycemia and dilutional hyponatremia also contribute to the development of myxedema coma. Reference : page 2293 Harrison's Principles of Internal Medicine 19th edition