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Myxoedema coma is a rare but life-threatening condition resulting from severe thyroid hormone deficiency. Despite having a low incidence, the mortality rate may be as high as 30–60%. The prompt recognition of clinical presentation and precipitating events allows earlier diagnosis and treatment reducing the probability of an adverse outcome. The risk of myxoedema coma is greatest in hypothyroid older patients exposed to a precipitating event such as infection or a systemic superimposed illness. The effect of thyroid hormone deficiency on multiple systems (cardiovascular, respiratory, gastrointestinal, renal, neuropsychiatric, haematologic and thermoregulatory) often blurs the diagnosis resulting in treatment delay. Proper treatment includes thyroid hormone administration and a multifaceted approach to the multiple metabolic derangements in order to optimize survival.

Thyroid storm is a rare presentation of exaggerated manifestations of thyrotoxicosis and represents a complex endocrine emergency with a high mortality rate. Multiple organs are affected leading to multisystemic decompensation. To facilitate early diagnosis, a scoring system has been developed based on thermoregulation dysfunction, central nervous system alteration, gastrointestinal symptoms, cardiovascular involvement, and presence of precipitating event. Treatment delay increases the likelihood of irreversible progression and ultimate demise. Hence, when the diagnosis is likely but indefinite, treatment for thyrotoxic storm should be initiated. Management is based on four main strategies directed to reducing thyroid gland hormone production and release, managing the effects of circulating thyroid hormone in the periphery, addressing the systemic decompensation and the precipitating event.