Background: Myxedema coma is a medical emergency seen in patients with primary hypothyroidism. The prognosis is poor if not diagnosed and treated early. Here we report a case of secondary hypothyroidism due to empty sella syndrome presenting with initial manifestation of myxedema coma which is exceedingly rare. Case Report: A middle aged lady presented with easy fatigability for four months, giddiness for one month and vomiting for four days. Clinical diagnosis of myxedema coma was made; she was treated with levothyroxine and laboratory evaluation revealed hypo-pituitarism due to empty sella syndrome. Conclusion: Myxedema coma is an endocrine emergency seen rarely in patients with secondary hypothyroidism but early detection and management reduces the mortality.