A 65-year-old patient presents to the emergency department with sudden onset of flashes of light, a shadow over the visual field, and floaters in their right eye. What is the most likely diagnosis?

Choice A Reason:

Night blindness, or difficulty seeing in low light, is not a primary symptom of macular degeneration. This condition primarily affects the macula, the central part of the retina responsible for sharp, central vision. Night blindness is more commonly associated with conditions like retinitis pigmentosa or vitamin A deficiency.

Choice B Reason:

Central vision loss is the hallmark of macular degeneration. This condition leads to the deterioration of the macula, causing blurred or lost central vision while peripheral vision remains intact. Patients often report difficulty reading, recognizing faces, and performing tasks that require fine visual detail3.

Choice C Reason:

Peripheral vision loss is not typically associated with macular degeneration. This condition affects the central part of the retina, leaving peripheral vision largely unaffected. Peripheral vision loss is more commonly seen in conditions like glaucoma.

Choice D Reason:

Double vision, or diplopia, is not a characteristic symptom of macular degeneration. This condition affects the clarity of central vision but does not typically cause double vision. Double vision can result from issues with the eye muscles or nerves, such as in cases of strabismus or cranial nerve palsies.

Choice A Reason:

Administering IV levothyroxine is the priority intervention for a patient with myxedema coma. Myxedema coma is a severe form of hypothyroidism that requires immediate thyroid hormone replacement to correct the deficiency and stabilize the patient’s condition. Intravenous levothyroxine is preferred because it provides a rapid increase in thyroid hormone levels, which is crucial for reversing the life-threatening symptoms of myxedema coma, such as hypothermia, bradycardia, and altered mental status.

Choice B Reason:

Starting broad-spectrum antibiotics is not the primary intervention for myxedema coma. While infections can precipitate myxedema coma and should be treated if present, the immediate priority is to address the severe hypothyroidism with thyroid hormone replacement. Antibiotics may be administered if an infection is suspected or confirmed, but they do not directly address the underlying thyroid hormone deficiency.

Choice C Reason:

Administering corticosteroids immediately is important but not the highest priority. Corticosteroids are often given to patients with myxedema coma to treat potential adrenal insufficiency, which can coexist with severe hypothyroidism. However, the primary intervention remains the administration of thyroid hormone replacement to correct the hypothyroid state.

Choice D Reason:

Initiating fluid restriction is not appropriate for managing myxedema coma. Patients with myxedema coma often require careful fluid management to address potential hyponatremia and maintain hemodynamic stability. Fluid restriction is not a standard intervention for this condition and does not address the critical need for thyroid hormone replacement.