Severe hypothyroidism and myxedema coma are uncommon causes of death and may be overlooked in unwitnessed home deaths. Herein, we report a fatal case of severe hypothyroidism after prior thyroid surgery and describe the postmortem computed tomography (PMCT), autopsy, and biochemical findings, focusing on how PMCT supported the recognition of a thyroid-related natural death. We reviewed scene information, non-contrast whole-body PMCT, complete autopsy findings, and postmortem biochemistry in a woman in her thirties with a history of childhood thyroid surgery and marked weight gain during the year before death. The decedent was found supine at home with her abdomen and lower extremities inside an electric kotatsu (Japanese heated table). PMCT showed marked obesity with soft-tissue thickening/edema-like changes, no normally preserved thyroid tissue, apparent cardiomegaly with pericardial effusion, and extensive tracheobronchial intraluminal material without a clear air–fluid level. Autopsy revealed cardiomegaly, heavy congested lungs, systemic visceral congestion, and large volumes of tenacious mucoid airway fluid with only a small amount of fine frothy foam. Postmortem biochemistry demonstrated markedly elevated thyroid-stimulating hormone, with low free thyroxine and free triiodothyronine levels, and no evidence of ketoacidosis or fulminant sepsis. The integrated findings supported a postmortem diagnosis of cardiopulmonary failure with widespread congestion, with long-standing severe hypothyroidism (consistent with myxedema coma) as a major component of the fatal process. • PMCT showed no normally recognizable thyroid gland after prior surgery • PMCT showed cardiomegaly with pericardial effusion and viscous airway contents • Autopsy confirmed systemic congestion and tenacious tracheobronchial secretions • Postmortem tests showed profound hypothyroidism consistent with myxedema coma • Minimal hepatic intravascular gas suggested no advanced decomposition on PMCT
Usui et al. (Fri,) studied this question.