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Myxedema

Hypothyroidism/Myxedema

Myxedema or severe hypothyroidism is clinical condition where the thyroid gland does not produce any thyroid hormone. In some cases, myxedema condition is also being referred to as underactive thyroid. Myxedema typically present with a distinct facial appearance, hoarse slow speech, and dryness of the skin.


Presentation

The symptomatology of myxedema varies depending on the severity of the hormonal deficiency. In general, the hormones progress in severity with age and starts to worsen with each passing year. Mild symptoms of myxedema like weight gain and fatigue hallmarks the beginning of the progression of the disease. The chronic decrease in body metabolism gives rise to more obvious symptomatology like:

Myxedema in children happens when the infant is born without a thyroid gland. Infants with hypothyroid will present with jaundice, protruding tongue, frequent choking, puffy face, poor muscle tone, constipation, and excessive sleepiness.

Hypothermia
  • Among important causative factors leading to catastrophic events in myxedema is life threatening hypothermia, heart and cerebral dysfunctions.[ncbi.nlm.nih.gov]
  • High mortality (30-60%) How do patients present (clinical diagnosis) AMS Hypothermia Hypotension Respiratory Failure Hypoglycemia Hyponatremia Potential physical exam findings Hypothermia Sluggish/flat affect Hair loss Puffy eyes Thin eyebrows Big tongue[emdocs.net]
  • Vital signs were notable for hypothermia (temperature, 34 C [93 F]), a heart rate of 50 beats per minute, and a respiratory rate of 12 breaths per minute.[nejm.org]
  • Other features include bradycardia/low voltage, hyponatremia, and hypothermia MUST rule out or consider concomitant adrenal insufficiency because if you administer synthroid before steroids, you can cause the patient to go into adrenal crisis T3 is 3x[uclaoliveview.org]
  • HYPOTHERMIA Another common clinical feature of myxedema coma is hypothermia.[aafp.org]
Fatigue
  • Mild symptoms of myxedema like weight gain and fatigue hallmarks the beginning of the progression of the disease.[symptoma.com]
  • CASE PRESENTATION: Fifty three-year old woman with metastatic squamous cell carcinoma currently on treatment with nivolumab presented with diffuse facial and tongue swelling, slurred speech, depressed mentation, fatigue and weakness.[ncbi.nlm.nih.gov]
  • Images in Clinical Medicine Joyce Kim, M.D. 2 Citing Articles A 56-year-old woman, who had not received medical care for 30 years, presented to the emergency department with progressively worsening fatigue and confusion.[nejm.org]
  • These symptoms include: Fatigue Lethargy Mental impairment Depression Cold intolerance Hoarseness Dry skin Weight gain Myxedema can be treated by managing the underlying cause of the disease, i.e. curing hypothyroidism.[differencebetween.info]
  • The clinical manifestations of hypothyroidism reflect one of two changes: 1) Slowed metabolism – accounts for the fatigue, cold intolerance, slow movement and speech, constipation, bradycardia, weight gain, delayed relaxation of DTRs 2) Accumulation of[errolozdalga.com]
Weight Gain
  • Mild symptoms of myxedema like weight gain and fatigue hallmarks the beginning of the progression of the disease.[symptoma.com]
  • ‘I changed my hairdresser but the possibility of myxoedema did not enter my head.’ 1.1 The more general condition associated with hypothyroidism, including weight gain, mental dullness, and sensitivity to cold.[en.oxforddictionaries.com]
  • These symptoms include: Fatigue Lethargy Mental impairment Depression Cold intolerance Hoarseness Dry skin Weight gain Myxedema can be treated by managing the underlying cause of the disease, i.e. curing hypothyroidism.[differencebetween.info]
  • The clinical manifestations of hypothyroidism reflect one of two changes: 1) Slowed metabolism – accounts for the fatigue, cold intolerance, slow movement and speech, constipation, bradycardia, weight gain, delayed relaxation of DTRs 2) Accumulation of[errolozdalga.com]
  • Today, myxedema and hypothyroidism are often used to describe the same condition — a low level of thyroid hormone that causes some of these symptoms: Sluggishness Weight gain Dry skin Cold intolerance Constipation Muscle aches Mental slowness Doctors[sharecare.com]
Cold Intolerance
  • Characteristic symptoms are weakness, cold intolerance, mental and physical slowness, dry skin, typical facies, and hoarse voice. Results of the total serum thyroxine and free thyroxine index tests usually will confirm the diagnosis.[ncbi.nlm.nih.gov]
  • Patients initially have cold intolerance that progresses to severe loss of heat from the body.[ehealthwall.com]
  • These symptoms include: Fatigue Lethargy Mental impairment Depression Cold intolerance Hoarseness Dry skin Weight gain Myxedema can be treated by managing the underlying cause of the disease, i.e. curing hypothyroidism.[differencebetween.info]
  • The clinical manifestations of hypothyroidism reflect one of two changes: 1) Slowed metabolism – accounts for the fatigue, cold intolerance, slow movement and speech, constipation, bradycardia, weight gain, delayed relaxation of DTRs 2) Accumulation of[errolozdalga.com]
  • Today, myxedema and hypothyroidism are often used to describe the same condition — a low level of thyroid hormone that causes some of these symptoms: Sluggishness Weight gain Dry skin Cold intolerance Constipation Muscle aches Mental slowness Doctors[sharecare.com]
Goiter
  • E03.9 Hypothyroidism, unspecified E04 Other nontoxic goiter E04.0 Nontoxic diffuse goiter E04.1 Nontoxic single thyroid nodule E04.2 Nontoxic multinodular goiter E04.8 Other specified nontoxic goiter E04.9 Nontoxic goiter, unspecified E05 Thyrotoxicosis[icd10data.com]
  • ‘The presence of goiter, coarse hair, dry skin, carotenemia, and myxedema indicates hypothyroidism.’[en.oxforddictionaries.com]
  • MORPHOLOGY OF THE PITUITARY 19 THE OPTIC CHIASM IN ENDOCRINOLOGIC 204 PARANEOPLASTIC ENDOCRINE 223 SEX HORMONES AND HUMAN 219 APPROACH TO THE PATIENT WITH 37 ADVERSE EFFECTS OF IODIDE 360 MORPHOLOGY OF THE THYROID 38 NONTOXIC GOITER 366 SYNTHESIS AND[books.google.de]
  • The thyroid gland may enlarge, producing a goiter in the neck. Orthodox therapy is based upon taking thyroid hormone daily to replace what is not there.[healthy.net]
  • Patients scheduled for surgical intervention for goiter and other thyroid masses should submit for close monitoring to prevent complications of hypothyroidism from ensuing.[symptoma.com]
Hoarseness
  • Myxedema typically present with a distinct facial appearance, hoarse slow speech, and dryness of the skin. The symptomatology of myxedema varies depending on the severity of the hormonal deficiency.[symptoma.com]
  • Characteristic symptoms are weakness, cold intolerance, mental and physical slowness, dry skin, typical facies, and hoarse voice. Results of the total serum thyroxine and free thyroxine index tests usually will confirm the diagnosis.[ncbi.nlm.nih.gov]
  • Myxoedema is responsible for the thickening of the tongue and the laryngeal and pharyngeal mucous membranes, which results in thick slurred speech and hoarseness, both of which are seen commonly in hypothyroidism.[en.wikipedia.org]
  • These symptoms include: Fatigue Lethargy Mental impairment Depression Cold intolerance Hoarseness Dry skin Weight gain Myxedema can be treated by managing the underlying cause of the disease, i.e. curing hypothyroidism.[differencebetween.info]
  • […] fatigue, cold intolerance, slow movement and speech, constipation, bradycardia, weight gain, delayed relaxation of DTRs 2) Accumulation of matrix glycosaminoglycans in interstitial spaces – leads to coarse hair and skin, puffy facies, enlarged tongue, hoarseness[errolozdalga.com]
Pleural Effusion
  • Fluid accumulation may cause pleural effusions and decreased diffusing capacity.[emedicine.com]
  • effusion and pericardial effusions); The heart may slow down and its ability to pump blood forward can be impaired; The gastrointestinal tract does not function well and sometimes it becomes paralyzed, thereby necessitating surgery; and Blood test abnormalities[rxlist.com]
  • Doctors may also conduct a Chest X-Ray, which can clearly display enlargement of heart or pleural effusions. An Abdominal Ultrasound examination may be carried out to detect Ascites.[hxbenefit.com]
Constipation
  • Infants with hypothyroid will present with jaundice, protruding tongue, frequent choking, puffy face, poor muscle tone, constipation, and excessive sleepiness.[symptoma.com]
  • Any chronic constipation present may be alleviated with laxative. Hepatic laxatives are the best as there will be the support of liver function, examples include Rumex crispus, Juglans cineria (Butternut).[healthy.net]
  • The clinical manifestations of hypothyroidism reflect one of two changes: 1) Slowed metabolism – accounts for the fatigue, cold intolerance, slow movement and speech, constipation, bradycardia, weight gain, delayed relaxation of DTRs 2) Accumulation of[errolozdalga.com]
  • Today, myxedema and hypothyroidism are often used to describe the same condition — a low level of thyroid hormone that causes some of these symptoms: Sluggishness Weight gain Dry skin Cold intolerance Constipation Muscle aches Mental slowness Doctors[sharecare.com]
Macroglossia
  • […] ischemia) -MICU admit Other valuable tidbits -Don’t hesitate to initiate sepsis care -If thyroid labs don’t come back in timely fashion, proceed with thyroid replacement -CK is often elevated -Potentially challenging intubation: oropharyngeal edema, macroglossia[emdocs.net]
  • Phenothiazines Phenytoin (Dilantin) Rifampin (Rifadin, Rimactane) Tranquilizers Stroke Surgery Trauma Physical Findings Physical findings in myxedema coma ( Table 2 ) may include the classic myxedematous face, which is characterized by generalized puffiness, macroglossia[aafp.org]
  • […] effusion RESP: respiratory depression, impaired respiratory muscle function, hypoxia and hypercapnia RENAL: bladder atony, urinary retention, urinary Na normal or high ELECTROLYTES: hyponatraemia from increased H2O reabsorption from high levels of ADH GI: macroglossia[lifeinthefastlane.com]
  • Physical examination may reveal hypothermia, hypoventilation, hypotension, bradycardia, dry coarse skin, macroglossia, and delayed deep-tendon reflexes.[ncbi.nlm.nih.gov]
  • Most patients have the physical features of severe hypothyroidism, including macroglossia, delayed reflexes, dry, rough skin and myxedematous facies, which results from the periorbital edema, pallor, hypercarotenemia, periorbital edema, and patchy hair[endocrinologyadvisor.com]
Hypertension
  • […] arrhythmias. [7] The reduction of the effect of beta-adrenergic receptors leads to prevalence of the effect of alpha-adrenergic receptors, increased catecholamines, and increased systemic vascular resistance, causing some patients to have diastolic hypertension[emedicine.com]
  • Absence of mild diastolic hypertension in severely hypothyroid patients is a warning sign of impending myxedema coma.[ncbi.nlm.nih.gov]
  • Due to her borderline high blood pressure records and gross pedal edema she was investigated on lines of gestational hypertension. Her kidney and liver function tests were normal.[omicsonline.org]
Diastolic Hypertension
  • hypertension and a narrowed pulse pressure.[emedicine.com]
  • Absence of mild diastolic hypertension in severely hypothyroid patients is a warning sign of impending myxedema coma.[ncbi.nlm.nih.gov]
  • BLOOD PRESSURE CHANGES Patients with compensated hypothyroidism often exhibit diastolic hypertension.[aafp.org]
Cardiomegaly
  • Cardiomegaly is common, and is thought to be due to either pericardial effusion or underlying heart disease and not to ventricular dilation induced by hypothyroidism.[emjournal.net]
  • However, macrocytic anemia and pernicious anemia caused by associated immune dysfunction are sometimes present. 13, 23 A chest radiograph may show cardiomegaly and pleural effusions.[aafp.org]
Jaundice
  • Infants with hypothyroid will present with jaundice, protruding tongue, frequent choking, puffy face, poor muscle tone, constipation, and excessive sleepiness.[symptoma.com]
  • No palmar erythema, asterixis, jaundice, or spider angiomata were appreciated. A lower extremity examination showed mild, non-pitting edema extending halfway up the shin.[cureus.com]
  • When newborns do have problems with hypothyroidism, the problems may include: Yellowing of the skin and whites of the eyes (jaundice).[mayoclinic.org]
Muscle Weakness
  • weakness, mechanical obstruction by a large tongue, and obesity-hypoventilation syndrome.[emedicine.com]
  • Other clinical manifestations of thyroid myopathy include diffuse myalgias, diffuse muscular hypertrophy associated with weakness and painful muscle cramps (Hoffman's syndrome), slowly progressive symmetric proximal muscle weakness and rhabdomyolysis.[cureus.com]
  • Hypothyroidism signs and symptoms may include: Fatigue Increased sensitivity to cold Constipation Dry skin Weight gain Puffy face Hoarseness Muscle weakness Elevated blood cholesterol level Muscle aches, tenderness and stiffness Pain, stiffness or swelling[mayoclinic.org]
Muscle Cramp
  • Other clinical manifestations of thyroid myopathy include diffuse myalgias, diffuse muscular hypertrophy associated with weakness and painful muscle cramps (Hoffman's syndrome), slowly progressive symmetric proximal muscle weakness and rhabdomyolysis.[cureus.com]
  • Muscle cramps, decreased hearing, mental disturbances, and menstrual irregularities are additional symptoms. Cutaneous features noted on physical examination include dry, scaly, yellow skin, puffy eyes, thinning of the eyebrows, and scant body hair.[emjournal.net]
Myalgia
  • Other clinical manifestations of thyroid myopathy include diffuse myalgias, diffuse muscular hypertrophy associated with weakness and painful muscle cramps (Hoffman's syndrome), slowly progressive symmetric proximal muscle weakness and rhabdomyolysis.[cureus.com]
Periorbital Edema
  • Most patients have the physical features of severe hypothyroidism, including macroglossia, delayed reflexes, dry, rough skin and myxedematous facies, which results from the periorbital edema, pallor, hypercarotenemia, periorbital edema, and patchy hair[endocrinologyadvisor.com]
  • You note that her face is puffy with periorbital edema and that her tongue seems enlarged. She's not drooling and her gag reflex is intact.[journals.lww.com]
  • edema, and coarse, sparse hair.[aafp.org]
  • An examination revealed normal vital signs, mild periorbital edema, and dry pale skin. The thyroid gland was not palpable.[cureus.com]
  • The patient had bilateral exophthalmos, conjunctival chemosis, periorbital edema and limitation of lateral gaze.[thedoctorsdoctor.com]
Alopecia
  • You also note diffuse alopecia and bilateral nonpitting pretibial edema, as well as diminished deep tendon reflexes. What's the situation? Mr. Granger said that when he arrived home from work and found his wife unresponsive, he called 911.[journals.lww.com]
  • View/Print Table TABLE 2 Physical Findings in Myxedema Coma Altered mentation Alopecia Bladder dystonia and distension Cardiovascular Elevated diastolic blood pressure—early Hypotension—late Bradycardia Delayed reflex relaxation Dry, cool, doughy skin[aafp.org]
Coarseness of the Skin
  • ‘The presence of goiter, coarse hair, dry skin, carotenemia, and myxedema indicates hypothyroidism.’[en.oxforddictionaries.com]
  • […] hair and skin, puffy facies, enlarged tongue, hoarseness The cardiovascular consequences of severe hypothyroidism are mainly bradycardia and decreased contractility, which can precipate or worsen CHF exacerbations.[errolozdalga.com]
Yellow Discoloration of the Skin
  • Your skin may be coarser You could have water retention Your skin could feel dryer than usual You may have an orange or yellow discoloration to your skin You may have areas under your skin that are filled with a “jelly-like” material and cause swelling[gudhealth.com]
Psychiatric Manifestation
  • Abstract Although hypothyroidism is associated with an increased prevalence of psychiatric manifestations, myxedema madness is rarely observed.[ncbi.nlm.nih.gov]
Amenorrhea
  • The changes come on gradually: enlarged tongue; thickened skin with underlying fluid causing puffiness, particularly in the face around the eyelids and in the hands; drowsiness; apathy; sensitivity to cold; failure to menstruate ( amenorrhea ) or excessive[britannica.com]
Irregular Menstruation
  • menstruation Impaired memory Depression Myxedema in children happens when the infant is born without a thyroid gland.[symptoma.com]
Confusion
  • These life-threatening symptoms may occur: Mental deterioration such as apathy, confusion, and psychosis Extremely low body temperature (hypothermia) Extremely slow heartbeat (fewer than 60 beats a minute) Heart failure Respiratory failure Death can occur[myhealth.alberta.ca]
  • Images in Clinical Medicine Joyce Kim, M.D. 2 Citing Articles A 56-year-old woman, who had not received medical care for 30 years, presented to the emergency department with progressively worsening fatigue and confusion.[nejm.org]
  • Along with the signs and symptoms of severe hypothyroidism, symptoms of myxedema crisis can include: decreased breathing (respiratory depression) lower than normal blood sodium levels hypothermia (low body temperature) confusion or mental slowness shock[healthline.com]
  • According to MedicineNet, patients also can have hallucinations, confusion, and seizures. The heart slows down and cannot pump blood effectively, breathing slows, and fluid may begin to accumulate around the heart and lungs.[newsmax.com]
Lethargy
  • These symptoms include: Fatigue Lethargy Mental impairment Depression Cold intolerance Hoarseness Dry skin Weight gain Myxedema can be treated by managing the underlying cause of the disease, i.e. curing hypothyroidism.[differencebetween.info]
  • The clinical course of lethargy proceeding to stupor and then coma is often hastened by drugs, especially sedatives, narcotics, antidepressants, and tranquilizers.[endocrinologyadvisor.com]
  • While symptoms of hypothyroidism at early stages can be mild, myxedema is characterized by severe degrees of these symptoms such as extreme cold intolerance, profound lethargy, and even unconsciousness.[newsmax.com]
  • For example, there may be fatigue, lethargy, mental impairment, depression and headache. Such patients additionally complain about dry skin, weight gain, constipation and cold intolerance.[ic.steadyhealth.com]
  • Usually somnolence and lethargy have been present for months. Lethargy may develop via stupor into a comatose state. There may have been transient episodes of reduced consciousness before a more complete variety develops.[ncbi.nlm.nih.gov]
Altered Mental Status
  • mental status (patient doesn’t have to be in a coma to qualify).[uclaoliveview.org]
  • The condition is diagnosed from a combination of abnormal thyroid function, physical examination findings of severe hypothyroidism, and altered mental status. Bradycardia, hypothermia, and hyponatremia are often present as well.[nejm.org]
  • But the patient’s condition deteriorated and she had altered mental status.[omicsonline.org]
Stupor
  • […] and coma with mcc 081 Nontraumatic stupor and coma without mcc 793 Full term neonate with major problems Convert E03.5 to ICD-9-CM Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No[icd10data.com]
  • Lethargy may develop via stupor into a comatose state. There may have been transient episodes of reduced consciousness before a more complete variety develops. Defective thermoregulation: hypothermia.[ncbi.nlm.nih.gov]
  • The clinical course of lethargy proceeding to stupor and then coma is often hastened by drugs, especially sedatives, narcotics, antidepressants, and tranquilizers.[endocrinologyadvisor.com]
  • Introduction Myxedema crisis is a potentially fatal complication of uncontrolled hypothyroidism manifesting as progressive mental deterioration like lethargy, stupor, delirium, or coma and multiple organ abnormalities.[omicsonline.org]
  • […] by, last update April 23, 2019 OVERVIEW extreme form of hypothyroidism high mortality CLINICAL FEATURES stupor hypothermia respiratory failure confusion coma dry skin sparse hair hoarse voice periorbital oedema CVS: non-pitting oedema of hands and feet[lifeinthefastlane.com]
Apathy
  • These life-threatening symptoms may occur: Mental deterioration such as apathy, confusion, and psychosis Extremely low body temperature (hypothermia) Extremely slow heartbeat (fewer than 60 beats a minute) Heart failure Respiratory failure Death can occur[myhealth.alberta.ca]
  • The changes come on gradually: enlarged tongue; thickened skin with underlying fluid causing puffiness, particularly in the face around the eyelids and in the hands; drowsiness; apathy; sensitivity to cold; failure to menstruate ( amenorrhea ) or excessive[britannica.com]
  • The initial symptoms include generalized fatigue, apathy, and mental sluggishness. Speech and intellectual functions become slowed. Patients with myxedema are unenthusiastic, cold intolerant, and frequently overweight.[definitions.net]
  • Symptoms and signs of myxedema coma include: Below normal temperature Decreased breathing Low blood pressure Low blood sugar Unresponsiveness Primary Nursing Diagnosis Activity intolerance related to weakness and apathy Diagnostic Evaluation Thyroid-stimulating[rnpedia.com]
  • This decline may be subtle, manifesting as apathy, neglect or a decrease in intellectual function; more obvious changes include confusion, psychosis and, rarely, coma.[aafp.org]

Workup

Patients that have signs and symptoms of myxedema should submit for blood test for thyroid hormone quantitative analysis. Blood levels of Thyroxine (T4) usually appears low due to thyroid gland dysfunction or aplasia (absence). The levels of thyroid stimulating hormone (TSH) from the pituitary gland is usually increased as a compensatory reaction to the decreasing thyroid hormone levels in an attempt to increase its level by stimulating the thyroid gland to produce more [8]. Women who are pregnant and those who intend to be pregnant with previous history thyroid dysfunction must submit for this thyroid test because of the risk of recurrence [9].

Pericardial Effusion
  • Abstract Tuberculosis is a leading cause of massive pericardial effusion and tamponade especially in underdeveloped and developing countries. Hypothyroidism is also associated with pericardial effusion with rare progression to tamponade.[ncbi.nlm.nih.gov]
  • Abstract Pericardial effusion is frequently found in patients diagnosed with hypothyroidism, yet it is rarely associated with cardiac tamponade.[ncbi.nlm.nih.gov]
  • Cardiovascular Cardiac contractility is impaired, leading to reduced stroke volume, low cardiac output, bradycardia and sometimes hypotension. [6] Reduced stroke volume in severe cases may also be due to pericardial effusions caused by the accumulation[emedicine.com]
  • Heart enlargement ( “myxedema heart” ) is often due to pericardial effusion. Heart rate is slow.[bestonhealth.com]
Hyponatremia
  • Hyponatremia can also contribute to altered mental function.[emedicine.com]
  • High mortality (30-60%) How do patients present (clinical diagnosis) AMS Hypothermia Hypotension Respiratory Failure Hypoglycemia Hyponatremia Potential physical exam findings Hypothermia Sluggish/flat affect Hair loss Puffy eyes Thin eyebrows Big tongue[emdocs.net]
  • In cases with severe symptomatic hyponatremia, 100 ml of 3% NaCl should be administered (Liamis et al. 2017).[ncbi.nlm.nih.gov]
  • Other features include bradycardia/low voltage, hyponatremia, and hypothermia MUST rule out or consider concomitant adrenal insufficiency because if you administer synthroid before steroids, you can cause the patient to go into adrenal crisis T3 is 3x[uclaoliveview.org]
Hypercholesterolemia
  • Patients with unexplained increase in body weight or hypercholesterolemia should be assessed for potential hypothyroidism. Measurement of serum TSH level is the most sensitive screening test for this disorder.[definitions.net]
  • The chronic decrease in body metabolism gives rise to more obvious symptomatology like: Constipation Chronic fatigue Increased sensitivity to cold Unexplained weight gain Edematous face Skin dryness Hoarseness of voice Weakness of the muscles Hypercholesterolemia[symptoma.com]
  • Laboratory examination may reveal anemia, hyponatremia, hypoglycaemia, hypercholesterolemia, and high serum creatine kinase concentrations. Most patients have low serum FT4 and high serum TSH.[ncbi.nlm.nih.gov]
  • The primary mechanism for hypercholesterolemia in hypothyroidism is accumulation of LDL cholesterol due to impairment in lipid clearance caused by a reduction in the number of cell surface receptors for LDL, resulting in decreased catabolism of LDL.[cureus.com]
  • Hypertension in conjunction with hypercholesterolemia may contribute to coronary artery disease and angina pectoris. A surgical scar on the neck may be present, but a palpable goiter is uncommon.[emjournal.net]
Macrocytic Anemia
  • anemia caused by vitamin B12 deficiency, or normocytic normochromic anemia, which may be secondary to decreased oxygen requirement and reduced erythropoietin. [8][emedicine.com]
  • Our patient's initial laboratory tests showed macrocytic anemia with normal B12 and folate levels, elevated serum CK and AST levels and abnormalities in lipid panel.[cureus.com]
  • However, macrocytic anemia and pernicious anemia caused by associated immune dysfunction are sometimes present. 13, 23 A chest radiograph may show cardiomegaly and pleural effusions.[aafp.org]
Hypertriglyceridemia
  • Reduced lipoprotein lipase activity is responsible for hypertriglyceridemia in hypothyroidism.[cureus.com]
T Wave Inversion
  • ECGs of myxedema coma patients have three classic features: 1) bradycardia, 2) low voltage, and 3) widespread T-wave inversions. Other possible features include QT prolongation, first degree AV block, or interventricular conduction delay.[sinaiem.org]
Pleural Effusion
  • Fluid accumulation may cause pleural effusions and decreased diffusing capacity.[emedicine.com]
  • effusion and pericardial effusions); The heart may slow down and its ability to pump blood forward can be impaired; The gastrointestinal tract does not function well and sometimes it becomes paralyzed, thereby necessitating surgery; and Blood test abnormalities[rxlist.com]
  • Doctors may also conduct a Chest X-Ray, which can clearly display enlargement of heart or pleural effusions. An Abdominal Ultrasound examination may be carried out to detect Ascites.[hxbenefit.com]

Treatment

In general, thyroid deficiency in myxedema is adequately replaced by synthetic thyroid hormones like levothyroxine. The daily maintenance of oral synthetic hormones reverses the signs and symptoms of myxedema among patients [10]. Fatigue symptoms gradually decreases within 1 to 2 weeks from the start of hormonal replacement. Treatment with oral synthetic thyroid hormones are usually given for life as maintenance.

Prognosis

The thyroid deficiency in myxedema is easily treated with synthetic thyroid hormones which are taken for life. Myxedema that complicates to coma and cardiovascular crisis carries a high mortality in up to 50% among those with late therapeutic interventions. Even if these myxedema complications are diagnosed and addressed promptly, mortality remains high at 25% [6]. Factors like old age, concomitant cardiac dysfunction, sepsis, persistent hypothermia, and hypotension worsens the prognosis of myxedema crisis [7].

Etiology

Myxedema as clinical condition that produce deficient thyroid hormones can result from a number of medical condition or event. These include:

Epidemiology

In the United States, myxedema is a common disorder of the elderly [4]. Myxedema or severe hypothyroid is seen in 8% of women and 2% of men beyond the age of 50 years old. In countries worldwide with no iodine food supply insufficiency, almost 8% of women above the age of 50 are suffering from myxedema.

The most common causes of myxedema internationally are autoimmune disorder and post-operation thyroid ablation. In regions with insufficient iodine supply however, iodine deficiency is the leading cause of the hypothyroid disorder. Neonatal myxedema is observed among patients with severe iodine deficiency clinically expressed as cretinism. This clinical condition abounds in the mountainous regions of Africa, Asia and South America. There are no racial predilection to the disease with women more prone in up to 4 times more than men.

Sex distribution
Age distribution

Pathophysiology

The thyroid hormone is a vital hormone in the human body needed for proper cell growth or maturity, modulates other hormones, and energy production. The low energy states leads to chronic inactivity that leads to obesity if hypothyroid states in myxedema is left unabated. The decreasing rate of drug metabolism can make the patient prone to over dosage from common medications like hypnotics, sedatives, anesthetics, and morphine. Neurologic symptoms in myxedema is due to the decreased thyroid hormones triiodothyronine (T3) and thyroxine (T4) which reduces the cerebral oxygen and glucose consumption. Cardiac function is significantly depressed due to the decreased contractility of the myocytes due to the low T3 hormones that decreases available supply of adenosine triphosphate (ATP) for the heart cells [5].

The decrease in cardiac output and the increase in the vascular resistance may lead to signs of cardiac failure like pulmonary effusion and pericardial effusion with edema. The fluid accumulation in the lungs impairs the oxygen exchange function of the organ. Long standing low cardiac output will lead to renal insufficiency and compromises the kidney. The low serum thyroid hormonal levels decreases intestinal motility that advertently leads to megacolon, gastric atony, and paralytic ileus.

Prevention

Myxedema with congenital causes are not preventable. Patients scheduled for surgical intervention for goiter and other thyroid masses should submit for close monitoring to prevent complications of hypothyroidism from ensuing. Proper dosage of thyroid drugs should always be observed to prevent untoward complications like myxedema. Mild infections of the thyroid gland like thyroiditis must ardently be treated to prevent dysfunction.

Summary

Myxedema or underactive thyroid is a medical condition where there is not enough thyroid hormone in the circulation. Myxedema is common among women beyond the age of 60 years old causing a physiologic imbalance to the body systems. Untreated myxedema leads to obesity, infertility, heart diseases, and arthritis. The therapeutic goal in the treatment of myxedema is the replacement of thyroid hormone with synthetic thyroid hormones which corrects the hormonal imbalance.

Patient Information

  • Definition: Myxedema or underactive thyroid is a medical condition where there is not enough thyroid hormone produced from the thyroid gland available in the circulation.
  • Cause: Myxedema is caused by autoimmune disorders, post-surgical complications, medications, infections, pregnancy, and radiation therapy.
  • Symptoms: Hypothyroidism signs of myxedema includes fatigue and unexplained weight gain. Progressive signs like constipation, dry skin, hoarseness of voice, arthritis, and bradycardia
  • Diagnosis: Patients with myxedema are subjected to blood test to determine the levels of thyroxine and TSH levels. 
  • Treatment and follow-up: The treatment of myxedema is basically by the replacement of the deficient thyroid hormone with oral synthetic thyroid hormone which is taken in for life. 

References

Article

  1. Wolter P, Dumez H, Schöffski P. Sunitinib and hypothyroidism. N Engl J Med. Apr 12 2007; 356(15):1580; author reply 1580-1.
  2. Vono-Toniolo J, Rivolta CM, Targovnik HM, Medeiros-Neto G, Kopp P. Naturally occurring mutations in the thyroglobulin gene. Thyroid. Sep 2005; 15(9):1021-33.
  3. Smit JW, Stokkel MP, Pereira AM, Romijn JA, Visser TJ. Bexarotene-induced hypothyroidism: bexarotene stimulates the peripheral metabolism of thyroid hormones. J Clin Endocrinol Metab. Jul 2007; 92(7):2496-9.
  4. Rehman SU, Cope DW, Senseney AD, et al. Thyroid disorders in elderly patients. South Med J. May 2005; 98(5):543-9.
  5. Diekman MJ, Harms MP, Endert E, et al. Endocrine factors related to changes in total peripheral vascular resistance after treatment of thyrotoxic and hypothyroid patients. Eur J Endocrinol. Apr 2001; 144(4):339-46.
  6. Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011; 2011:493462.
  7. Rodríguez I, Fluiters E, Pérez-Méndez LF, et al. Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution. J Endocrinol. Feb 2004; 180(2):347-50.
  8. Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002). Thyroid. Dec 2007; 17(12):1211-23.
  9. Stuckey BG, Kent GN, Ward LC, Brown SJ, Walsh JP. Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction. Clin Endocrinol (Oxf). Sep 2010; 73(3):389-95.
  10. McDermott MT. Does combination T4 and T3 therapy make sense? Endocr Pract. Sep-Oct 2012; 18(5):750-7.

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Last updated: 2017-08-09 18:12