Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Myxedema definition of myxedema by the free dictionary. Patients manifest a marked impairment of central nervous system function and cardiovascular decompensation. Burman, in clinical management of thyroid disease, 2009. Hypothyroidism is a prevalent condition in the general population that is treatable with appropriately dosed thyroid hormone replacement medication. A new look into an old crisis article pdf available in journal of thyroid research 201112. 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. 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. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a clinical challenge. Evaluation of a patient in a coma is comprehensive.
Myxedema definition, symptoms, what is, treatment, pictures. Myxedema coma definition, symptoms, causes, treatment. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory failure from. It is defined by a group of characteristic clinical features and not by laboratory evidence of severe. Because most atrisk patients, including those with known hypothyroidism, thyroidectomy or previous radioactive iodine therapy, are routinely followed by readily available tsh. Instead, the diagnostic coding for these patients included. 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. Traumatic brain injuries are the most frequent cause. Diagnosis diagnosis is clinical thyroid panel reflects chronic state 43. Myxedema coma was first reported by ord in 1879 in london. An atypical case of myxedema coma with concomitant. Infections and noncompliance with thyroid supplements are the major precipitating factors. Progress in neurology and psychiatry july august 2016. First, lets take a look at hypothyroidism to see what symptoms lead to a patient being in a myxedema coma.
Patients are often placed in the intensive care unit for continuous monitoring and treatment. Myxedema symptoms, diagnosis, treatments and causes. Myxedema coma is a rare clinical condition that represents severe hypothyroidism decompensation usually occurs in patient with longstanding. Welcome to journal of the association of physicians of india. This progression is usually accelerated by the triggers mentioned above, like heart failure, trauma, or infection.
Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. It is known to be common in the elderly, and is mainly accompanied with cardiogenic. A disease caused by decreased activity of the thyroid gland in adults and characterized by dry skin, swellings around the lips and nose. These adaptations include peripheral vasoconstriction to maintain core body temperature. 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. In some cases, myxedema condition is also being referred to as underactive thyroid. Shraga, a staff physician at millspeninsula emergency medical associates, writes at medscape. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Abstract myxedema coma annals of internal medicine. It is mainly caused by a considerable decrease in the level of thyroid hormone in the. Myxedema is merely brought about by hypothyroidism. Myxedema crisis is commonly seen in older patients, especially in women, and is associated with signs of hypothyroidism, hypothermia, hyponatraemia, hypercarbia, and hypoxemia.
A case of myxedema coma presenting as a brain stem infarct in a 74yearold korean woman. Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism. Myxedema crisis can be treated and managed if it is diagnosed early. Decompensated hypothyroidism may be conceptualized as hypothyroidism causing organ failure. 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 crisis is a lifethreatening extreme form of hypothyroidism with a high mortality rate if left untreated.
Additional symptoms include swelling of the arms and legs and ascites. Read and know what is myxedema as well as all about its causes, symptoms, diagnosis and treatment. 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. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. 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. The condition is prompted by the reduced production of the thyroid hormone by the thyroid gland. This is a life threatening condition that is caused by a deficiency in the thyroid gland causing hypothyroidism. This is a lifethreatening state that requires immediate medical. May 31, 2017 myxedema coma is the most severe manifestation of hypothyroidism. Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma. Infrequently, patients will present with myxedema coma, characterized by hypothermia, hypotension, bradycardia, and altered mental status in the setting of severe hypothyroidism. Myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates.
Myxedema coma definition of myxedema coma by medical dictionary. Myxedema coma is a rare medical condition that is the extreme manifestation of severe hypothyroidism. Primary symptoms of myxedema coma are altered mental status and low body temperature. Myxedema can occur in the lower leg pretibial myxedema and behind the eyes exophthalmos. Hypothyroidism and myxedema coma clinical presentation. 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.
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. Clients who have been taking levothyroxine and suddenly stop the medication are also at risk. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. 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. Myxedema coma definition of myxedema coma by medical. It is typically treated as a lifethreatening emergency. Myxedema coma has also been known to manifest in a number of unusual. Emerson myxedema coma is a syndrome that occurs in advanced untreated hypothyroidism 1,2,3,4,5. The mortality rates may be as high as 2560% even with best possible treatment 15.
Myxedema coma carries a high mortality and morbidity rate. Myxedema is an ailment that is characterized by a thickened and enlarged skin. 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. Jun 29, 2017 myxedema is an ailment that is characterized by a thickened and enlarged skin. Man with myxedema or severe hypothyroidism showing an expressionless face, puffiness around the eyes and pallor.
Myxedema coma, a rare yet fatal disease, can present clinicians with a diagnostic dilemma because patients pre sent with altered consciousness. Myxedema madness definition of myxedema madness by medical. Myxedema coma is a state of decompensated 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.
Bizarre statements abound, such as in myxedema, because of the reduced cardiac output and vasomotor changes, lengthy syncope seems to be common. Pdf myxedema coma successfully treated by low dose oral. 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. Myxedema coma is a severe lifethreatening form of hypothyroidism that is associated with a high mortality rate. Myxedema is a condition characterized by a thickening and swelling of the bodys soft tissues, says dr. Oct 10, 2018 myxedema coma carries a high mortality and morbidity rate. It is mainly caused by a considerable decrease in the level of thyroid hormone in the blood. First, lets take a look at hypothyroidism to see what symptoms lead. Hypothyroidism depresses metabolic rate, thus seriously affecting all body system.
Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death. Patients are identified on the basis of a low index. 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. Myxedema madness definition of myxedema madness by the. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing.
Myxedema is known to occur in various forms of hyperthyroidism, including graves disease. However, the term is also used to describe a dermatological change that can occur in hyperthyroidism and rare paradoxical cases of hypothyroidism. It results from severe hypothyroidism and affects almost every organ. Myxedema information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. We believe they are the first survival cases to be reported in the. Signs and symptoms include hypothermia, bradycardia, altered mental status. 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. Myxedema coma is 4 to 8 times more common among women. 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 madness definition of myxedema madness by the free. Myxedema typically present with a distinct facial appearance, hoarse slow speech, and dryness of the skin.
Myxedema and coma severe hypothyroidism endotext ncbi. Pdf raionale myxedema coma mc is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental status and. Sep 15, 2011 myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Myxedema coma treatment, symptoms, causes, diagnosis. 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. Myxedema coma is a health condition associated with decreased mental status. In the american medical literature, we have 3 reports 1618 of myxedema coma. It is a medical emergency and associated with increased risk of death. If no treatment is administered, a rare but lifethreatening condition called myxedema coma can result. Jordan, md myxedema coma is the most severe expression of hypothyroidism. Case report, diagnosis, emergency, myxedema coma, renal failure. Create a free account to read full articles and access webexclusive content on.
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. Myxedematous coma is a syndrome that results from the intense reduction of the thyroid hormone synthesis. 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. 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. The construct of myxedema coma sets clinicians up for diagnostic failure. It is also used to describe a dermatological change that. Diagnosis of myxedema coma complicated by renal failure. 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 coma is a condition where longterm hypothyroidism is not treated or is poorly controlled. All patients with an admitting diagnosis of myxedema coma recorded in their charts between january 1, 2005 and june, 2010 were identified.
Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling. 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. Very rarely do we see patients presenting with the symptoms of myxedema coma. 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. Myxedema, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult. Myxedema coma, caused by severe lack of thyroid hormone, is characterized by. Myxedema madness definition of myxedema madness by. It is typically caused by a precipitating event in an untreated or partially treated patient. Myxoedema coma is a rare and life threatening medical emergency with a high mortality rate. In this latter sense, myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. Nov 02, 2016 myxedema coma was first reported by ord in 1879 in london.
Myxedema madness synonyms, myxedema madness pronunciation, myxedema madness translation, english dictionary definition of myxedema madness. Risk factors for death in patients with 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. Patients might present with different organ specific symptoms.
Myxedema or severe hypothyroidism is clinical condition where the thyroid gland does not produce any thyroid hormone. The high mortality rate of 2550 % makes early diagnosis and treatment imperative 1, 2. 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. Therefore, timely recognition and proper management is critical. 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. Three cases of myxedema with terminal coma were described in 1888 by a committee of the clinical society of london. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than. Description myxedema coma is a lifethreatening condition in which patients with underlying throid dysfunction exhibit exaggerated manifestations of hypothyroidism. Myxedema is a term used synonymously with severe hypothyroidism. 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.
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