Myxedema coma is a rare and life-threatening consequence of severe hypothyroidism, often precipitated by physiologic stressors. While cardiac manifestations are common, they are typically reversible with prompt treatment. Here, we report a case of a 23-year-old male with untreated hypothyroidism who presented with myxedema coma-induced cardiomyopathy leading to refractory cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and, ultimately, orthotopic heart transplantation (OHT). Our case highlights a rare occurrence of refractory shock necessitating mechanical support as a bridge to a cardiac transplant. We emphasize early recognition, aggressive management, and a low threshold to escalate care to mitigate the high mortality associated with myxedema coma.