Multiple acute vertebral fractures during recovery from myxedema coma

Severe hypothyroidism may progress to myxedema coma, a life-threatening condition requiring urgent hormonal replacement. Although thyroid hormones and glucocorticoids are known to influence bone remodeling, no clear association between appropriate treatment of hypothyroidism and incident fracture risk has been demonstrated. We report the case of a 60-year-old postmenopausal woman with untreated primary hypothyroidism who presented with myxedema coma, precipitated by bacterial pneumonia. She was treated with hydrocortisone followed by levothyroxine replacement therapy. Two weeks after treatment initiation, she developed acute thoracolumbar pain, and follow-up computed tomography demonstrated multiple vertebral fractures extending from T8 to L5. Comparative imaging confirmed that only a T12 fracture had been present at baseline. Secondary causes of osteoporosis were excluded. Thyroid function testing at the time of evaluation showed no biochemical evidence of overtreatment. This case documents the occurrence of multiple vertebral fractures during early recovery from myxedema coma in a patient with evidence suggesting preexisting bone fragility. Although causality cannot be established, clinicians should be aware of this possibility during the early recovery phase of severe hypothyroidism.