A 34-year-old female with a history of hypothyroidism is unresponsive with facial swelling and cold skin. Which diagnosis is most likely?

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This scenario tests recognizing myxedema coma in a patient with known hypothyroidism. Myxedema refers to severe hypothyroidism with diffuse nonpitting edema caused by mucopolysaccharide buildup in tissues. When it progresses to coma, mental status deteriorates and the patient becomes unresponsive, often with hypothermia and cold, dry skin. The facial swelling described is the classic myxedema feature, and together with unresponsiveness and cold skin in someone with hypothyroidism points to this emergency. Addison disease would present with fatigue, abdominal symptoms, electrolyte disturbances, and often hypotension—not the focal edema pattern here. Thyrotoxicosis causes warmth, sweating, tachycardia, and agitation, not cold skin or edema. So the most likely diagnosis is myxedema (myxedema coma), which requires urgent thyroid hormone replacement and supportive care.