Myxedema coma is a rare medical condition that is the extreme manifestation of severe hypothyroidism. Myxedema is an ailment that is characterized by a thickened and enlarged skin. Mild myxedema coma usually is treated by a general practitioner or internist while moderate to severe myxedema coma is treated and managed by an endocrinologist. It is also used to describe a dermatological change that. These adaptations include peripheral vasoconstriction to maintain core body temperature. Myxedema coma was first reported by ord in 1879 in london. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a clinical challenge.
Findings neck thyroidectomy scar goiter uncommon dermatologic dry, scaly, yellow skin loss of lateral 3rd of eyebrows nonpitting waxy edema of face extremities 41. Myxedema madness definition of myxedema madness by. Myxedema and coma severe hypothyroidism endotext ncbi. Infrequently, patients will present with myxedema coma, characterized by hypothermia, hypotension, bradycardia, and altered mental status in the setting of severe hypothyroidism. Myxedema crisis is a lifethreatening extreme form of hypothyroidism with a high mortality rate if left untreated. Patients manifest a marked impairment of central nervous system function and cardiovascular decompensation. Myxedema can occur in the lower leg pretibial myxedema and behind the eyes exophthalmos. Burman, in clinical management of thyroid disease, 2009. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory failure from.
Myxedema coma is 4 to 8 times more common among women. Read and know what is myxedema as well as all about its causes, symptoms, diagnosis and treatment. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing. Myxedema coma is a rare clinical condition that represents severe hypothyroidism decompensation usually occurs in patient with longstanding. Create a free account to read full articles and access webexclusive content on. Myxedema coma treatment, symptoms, causes, diagnosis. Diagnosis diagnosis is clinical thyroid panel reflects chronic state 43. Instead, the diagnostic coding for these patients included. A person may have lab values identical to a normal hypothyroid state, but a stressful event such as an infection, myocardial infarction or stroke precipitates the myxedema coma state, usually in the elderly. Evaluation of a patient in a coma is comprehensive.
The object of this study is to report 6 survival cases of myxedema with coma and shock and one survival case of myxedema in shock. Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism. Myxedema is a condition characterized by a thickening and swelling of the bodys soft tissues, says dr. Myxedema coma, also known simply as myxedema, is a rare but potentially deadly manifestation of severe hypothyroidism. Welcome to journal of the association of physicians of india. It is mainly caused by a considerable decrease in the level of thyroid hormone in the. It is typically treated as a lifethreatening emergency. Description myxedema coma is a lifethreatening condition in which patients with underlying throid dysfunction exhibit exaggerated manifestations of hypothyroidism. A disease caused by decreased activity of the thyroid gland in adults and characterized by dry skin, swellings around the lips and nose. Hypothyroidism depresses metabolic rate, thus seriously affecting all body system. Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma.
It is mainly caused by a considerable decrease in the level of thyroid hormone in the blood. Myxedema coma definition, symptoms, causes, treatment. Bizarre statements abound, such as in myxedema, because of the reduced cardiac output and vasomotor changes, lengthy syncope seems to be common. Myxedema crisis can be treated and managed if it is diagnosed early. In some cases, myxedema condition is also being referred to as underactive thyroid. Myxedema is merely brought about by hypothyroidism. Apr 25, 2018 myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis.
Myxedematous coma is a syndrome that results from the intense reduction of the thyroid hormone synthesis. Low intracellular t3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Myxedema information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. A new look into an old crisis article pdf available in journal of thyroid research 201112. Myxedema coma, caused by severe lack of thyroid hormone, is characterized by. Risk factors for death in patients with myxedema coma. Jan 11, 2012 myxedema is a rare skin condition that has a low incidence across the world but can have fatal consequences if left untreated. The assumption is made that physiological aberrations in myxedema coma must be identical with those changes seen in induced hypothermia, since hypothermia often accompanies the former.
It is typically caused by a precipitating event in an untreated or partially treated patient. Clients who have been taking levothyroxine and suddenly stop the. Signs and symptoms include hypothermia, bradycardia, altered mental status. Patients are identified on the basis of a low index. Myxedema coma is preceded by a long history of hypothyroidismrelated symptoms, such as generalized fatigue, cold intolerance, constipation, and dry skin, which slowly progress into more pronounced clinical manifestations such as lethargy, delirium, and coma. First, lets take a look at hypothyroidism to see what symptoms lead to a patient being in a myxedema coma. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than frankly comatose. In this latter sense, myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. Myxedema madness definition of myxedema madness by the free.
Infections and noncompliance with thyroid supplements are the major precipitating factors. The thyroid gland, located at the front part of the neck, is responsible for making substances called thyroid hormones that are important for all body cells to work. The high mortality rate of 2550 % makes early diagnosis and treatment imperative 1, 2. Pdf myxedema coma successfully treated by low dose oral. Myxedema coma is a health condition associated with decreased mental status.
It is known to be common in the elderly, and is mainly accompanied with cardiogenic. Myxedema is a term used synonymously with severe hypothyroidism. There are some triggering factors like exposition to low temperatures, infections, irregular performance of hormone replacement therapy in patients with hypothyroidism, adverse reactions of medications like amiodarone, lithium, anesthetics, hypnotics, sedatives or tranquilizers. Clients who have been taking levothyroxine and suddenly stop the medication are also at risk. An atypical case of myxedema coma with concomitant. It is defined by a group of characteristic clinical features and not by laboratory evidence of severe. Myxedema typically present with a distinct facial appearance, hoarse slow speech, and dryness of the skin.
In the american medical literature, we have 3 reports 1618 of myxedema coma. Drugs used to treat myxedema coma the following list of medications are in some way related to, or used in the treatment of this condition. Oct 10, 2018 myxedema coma carries a high mortality and morbidity rate. It is a medical emergency and associated with increased risk of death. Progress in neurology and psychiatry july august 2016. However, the term is also used to describe a dermatological change that can occur in hyperthyroidism and rare paradoxical cases of hypothyroidism. Mar 24, 2020 thyroidectomy scar in patients with altered mental status, suggests myxedema coma as a potential cause a swedish study, by mourtzinis et al, found the rates of hypothyroidism and hyperthyroidism in patients with atrial fibrillation to be 5. Nov 02, 2016 myxedema coma was first reported by ord in 1879 in london. Myxedema coma is a state of decompensated hypothyroidism. Factors suggesting a poor prognosis are older age, persistent hypothermia, or bradycardia, lower degree of consciousness by glasgow coma scale, multiorgan impairment indicated by high apache acute physiology and chronic health evaluation ii score. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. Patients might present with different organ specific symptoms. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. Myxedema, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult.
Traumatic brain injuries are the most frequent cause. Myxedema coma is an endocrinologic emergency and is the most clinically severe form of hypothyroidism. Abstract myxedema coma annals of internal medicine. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Myxedema coma is a severe lifethreatening form of hypothyroidism that is associated with a high mortality rate. Myxedema symptoms, diagnosis, treatments and causes. Primary symptoms of myxedema coma are altered mental status and low body temperature. Myxedema coma is a lifethreatening condition that occurs when hypothyroidism is untreated or when a stressor such as infection, heart failure, stroke, or surgery affects an individual who has hypothyroidism. Myxedema coma is a condition where longterm hypothyroidism is not treated or is poorly controlled.
Shraga, a staff physician at millspeninsula emergency medical associates, writes at medscape. Very rarely do we see patients presenting with the symptoms of myxedema coma. Pdf raionale myxedema coma mc is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental status and. It is a rare disorder, with only approximately 300 cases described in the literature typically elderly females have longstanding, undiagnosed hypothyroidism more than 90% of cases occur during winter months 5. The diagnosis of myxedema coma is made when the three key diagnostic features of myxedema coma are present, which include altered mental status, hypothermia or absence of fever and a precipitating event such as cold exposure, infection, drugs. This is a lifethreatening state that requires immediate medical.
This is a life threatening condition that is caused by a deficiency in the thyroid gland causing hypothyroidism. All patients with an admitting diagnosis of myxedema coma recorded in their charts between january 1, 2005 and june, 2010 were identified. Myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than. It is a rare complication arising due to acute underlying hypothyroidism and also associated to hypoxia low oxygen, hypoventilation insufficient breathing, low blood pressure, hypercapnia, low sodium and low core body temperature. It can be brought about by removal of the thyroid for any cause, by a cessation of function of the gland, or simply by glandular atrophy.
Precipitating factors may include but are limited to infection, trauma, surgery, heart failure, stroke, or central nervous system depressants. Three cases of myxedema with terminal coma were described in 1888 by a committee of the clinical society of london. Myxedema madness definition of myxedema madness by medical. Dec 26, 2018 myxedema crisis or coma, is a rare and potentially fatal condition caused by low levels of thyroid hormones produced by the thyroid gland. Jun 29, 2017 myxedema is an ailment that is characterized by a thickened and enlarged skin. Myxedema coma has also been known to manifest in a number of unusual. Myxedema coma is a severe life threatening form of decompensated hypothyroidism with a high mortality rate commonly seen in elderly hospitalized females with untreated hypothyroidism, although it may occur in young as well as pregnant females too. Sep 15, 2011 myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. The aim of this study was to identify the factors that may increase the risk of death for the patients hospitalized for myxedema coma. Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Emerson myxedema coma is a syndrome that occurs in advanced untreated hypothyroidism 1,2,3,4,5. Myxedema madness definition of myxedema madness by the. The mortality rates may be as high as 2560% even with best possible treatment 15.
Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death. Jordan, md myxedema coma is the most severe expression of hypothyroidism. Diagnosis of myxedema coma complicated by renal failure. Myxedema coma, a rare yet fatal disease, can present clinicians with a diagnostic dilemma because patients pre sent with altered consciousness. Myxedema definition of myxedema by the free dictionary. Thyroidectomy scar in patients with altered mental status, suggests myxedema coma as a potential cause a swedish study, by mourtzinis et al, found the rates of hypothyroidism and hyperthyroidism in patients with atrial fibrillation to be 5. May 31, 2017 myxedema coma is the most severe manifestation of hypothyroidism. Case report, diagnosis, emergency, myxedema coma, renal failure. The condition is prompted by the reduced production of the thyroid hormone by the thyroid gland. A case of myxedema coma presenting as a brain stem infarct in a 74yearold korean woman. Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling.
Hypothyroidism and myxedema coma clinical presentation. Myxoedema coma is a rare and life threatening medical emergency with a high mortality rate. Myxedema or severe hypothyroidism is clinical condition where the thyroid gland does not produce any thyroid hormone. It can result from any of the usual causes of hypothyroidism, particularly chronic autoimmune thyroiditis, usually precipitated by an acute event such as infection, myocardial infarction, cold exposure, or the administration of diuretics and sedative drugs, especially opioids. A clinical form of hypothyroidism which is more common in the elderly, characterised by dementia, delirium, impaired hearing and memory, acalculia, somnolence, mental withdrawal, paranoia, and possibly hallucinations and frank psychosis. Myxedema coma definition of myxedema coma by medical. Decompensated hypothyroidism may be conceptualized as hypothyroidism causing organ failure. It results from severe hypothyroidism and affects almost every organ. Myxedema crisis is commonly seen in older patients, especially in women, and is associated with signs of hypothyroidism, hypothermia, hyponatraemia, hypercarbia, and hypoxemia. Man with myxedema or severe hypothyroidism showing an expressionless face, puffiness around the eyes and pallor.
Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. Therefore, timely recognition and proper management is critical. Apr 16, 2014 myxoedema coma can be regarded as a form of decompensated hypothyroidism in which the adaptations of the body to untreated hypothyroidism fail to maintain homoeostasis and become overwhelmed by hypothermia, infection or other precipitating factors. This progression is usually accelerated by the triggers mentioned above, like heart failure, trauma, or infection. Myxedema is known to occur in various forms of hyperthyroidism, including graves disease. Our goal is to inform the global em community with timely and high yield content about what providers like you are seeing and doing everyday in your local ed.
Myxedema definition, symptoms, what is, treatment, pictures. If no treatment is administered, a rare but lifethreatening condition called myxedema coma can result. Additional symptoms include swelling of the arms and legs and ascites. Hypothyroidism is a prevalent condition in the general population that is treatable with appropriately dosed thyroid hormone replacement medication. Myxedema coma carries a high mortality and morbidity rate. Patients are often placed in the intensive care unit for continuous monitoring and treatment.
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