Man with myxedema or severe hypothyroidism showing an expressionless face, puffiness around the eyes and pallor. Clinical characteristics and outcomes of myxedema coma. A thyroid stimulating hormone tsh level of 206 mul and a free. If the diagnosis of myxedema coma is suspected, a blood sample should be drawn prior to treatment for measurement of. Myxedema coma treatment, symptoms, causes, diagnosis. Untreated or unrecognized hypothyroidism may progress to severe decompensated hypothyroidism or myxedema coma. Hypothyroidism is a common endocrine disorder resulting from a deficiency in thyroid hormone rev endocr metab disord 2016 may 7 epub ahead of print it is imperative to distinguish primary hypothyroidism from secondary tertiary hypothyroidism indian j endocrinol metab 2011. The mortality rates may be as high as 2560% even with best possible treatment 15. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in.
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. Myxedema is known to occur in various forms of hyperthyroidism, including graves disease. 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. Myxedema can occur in the lower leg pretibial myxedema and behind the eyes exophthalmos. May 31, 2017 myxedema coma is the most severe manifestation of hypothyroidism. Myxedema coma is a state of decompensated hypothyroidism. Myxedema crisis can be treated and managed if it is diagnosed early.
Myxedema and coma severe hypothyroidism endotext ncbi. Pdf raionale myxedema coma mc is extremely rare but lethal in pediatric. Myxedema coma was first reported by ord in 1879 in london. Myxedematous coma is a syndrome that results from the intense reduction of the thyroid hormone synthesis. 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. An elevated thyroidstimulating hormone will confirm the myxedema diagnosis, but treatment cant be delayed while awaiting the lab results. Myxedema coma is a severe form of hypothyroidism low thyroid function. Mar 24, 2020 popoveniuc g, chandra t, sud a, sharma m, blackman mr, burman kd, et al. The patient was concurrently diagnosed with myxedema coma, started on stress. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs.
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. Myxedema coma is a rare and potentially fatal manifestation of severe hypothyroidism that can be successfully treated using intravenous levothyroxine. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than. The construct of myxedema coma sets clinicians up for diagnostic failure. In the last 7 years numerous reports 115 have appeared in the british medical literature dealing with myxedema, shock, and coma. Myxedema coma, also known simply as myxedema, is a rare but potentially deadly manifestation of severe hypothyroidism. Relatively few cases are reported in the literature since the first case was apparently reported from the st. Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling. A survey of these reports indicates that 19 out of 25 patients died in spite of vigorous treatment with corticosteroids, vasopressors, thyroid compounds, antibiotics, warming, and electrolyte and fluid correction. In this latter sense, myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory. Clinical data for our 5 patients and 82 cases from the medline search were pooled and factors associated with mortality were sought among age, gender, presence of cardiac or pulmonary complications, and doses of thyroid.
S99, as the causes are very different in severe hypothyroidism decompensation, myxedema. Dec 01, 2000 myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. Since 95% of cases of myxedema coma are due to primary hypothyroidism, the laboratory findings include an elevated serum tsh and low or undetectable total and free serum t4 concentrations. Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. Myxoedema coma, the extreme manifestation of hypothyroidism, is exceedingly rare due to the widespread availability of thyroidstimulating hormone assay. The therapeutic endpoints of levothyroxine therapy in patients with myxedema coma should be improved mental status, improved cardiac function, and improved pulmonary function. Ono y, ono s, yasunaga h, matsui h, fushimi k, tanaka y. Analysis of a national inpatient database in japan. Factors associated with mortality of myxedema coma. Popoveniuc g, chandra t, sud a, sharma m, blackman mr, burman kd, et al. It traditionally occurs in hypothyroid states, and recognition of this generalized nonpitting edema provides the physician with a reason to suspect hypothyroidism.
Primary symptoms of myxedema coma are altered mental status and low body temperature. Thyroid hormones may be measured every 1 to 2 days. Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. 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. Myxedema coma overview 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 properly. Decompensated hypothyroidism may be conceptualized as hypothyroidism causing organ failure. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing. What is the role of glucocorticoid therapy in the treatment.
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. It can also develop when someone stops taking their thyroid medication. A case of myxedema coma presenting as a brain stem infarct in a 74yearold korean woman. Myxedema coma definition of myxedema coma by medical dictionary. Three cases of myxedema with terminal coma were described in 1888 by a committee of the clinical society of london. Myxedema coma is rare in dogs but the diagnosis is complicated by the fact that, as in humans, dogs with myxedema coma often do not have myxedema and are rarely comatose. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive. It is an endocrine emergency associated with a high mortality rate. These adaptations include peripheral vasoconstriction to maintain core body temperature. Patients are often placed in the intensive care unit for continuous monitoring and treatment. In the patient with central hypothyroidism, the diagnosis of myxedema coma maybe very difficult, as serum tsh concentrations will be normal or low.
Myxedema coma is an endocrinologic emergency and is the most clinically severe form of hypothyroidism. Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma. 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. Jul 06, 2017 myxedema is a result of undiagnosed or untreated severe hypothyroidism. The most common presentation of the myxedema coma is a elderly women hospitalized with long standing hypothyroidism untreated, with 80% of cases occurring in women older than 60 years. Myxedema is a term used synonymously with severe hypothyroidism. However, the term is also used to describe a dermatological change that can occur in hyperthyroidism and rare paradoxical cases of hypothyroidism. Create a free account to read full articles and access webexclusive content on. Myxedema definition of myxedema by the free dictionary. Decompensated hypothyroidism myxedema coma emcrit project. Myxedema coma annals of internal medicine american.
Myxedema coma is a rare but severe complication of myxedema. The paucity of cases may be due to either underreporting or improvement in the diagnosis and treatment of uncomplicated hypothyroidism. Childhood cases of myxedema coma are extremely rare. It is a lifethreatening complication with a mortality rate of 2560 percent and tends to affect older adults. Traumatic brain injuries are the most frequent cause. Myxedema coma in a hypothermic, obtunded patient with. Sep 15, 2011 myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. We report a case of a 5yearold girl transferred to a tertiary care pediatric emergency department with hypoxemia and altered mental status.
Neonatal screening programs for congenital hypothyroidism show that in many areas around the world hypothyroidism appears in 1 of every 4000 newborns. Finora is now affiliated with the veterinary emergency clinic and referral centre, toronto, ontario, canada. Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death. Myxedema coma myxedema coma myxedema coma carotid artery aneurysm resulting in myxedema coma impending myxedema coma as the initial presentation of lung cancer. Myxedema coma is a rare, hardtodiagnose condition with a very high mortality rate. Hypothyroidism and myxedema coma differential diagnoses. Combine homeopathy with diet and nutrition of hypothyroidism or myxoedema and get the ultimate treatment for your ailment.
Myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates. Highdose thyroid hormone replacement has been recommended for treatment of myxedema coma mc while questions of safety of the therapy and of efficacy of lowdose thyroid hormone replacement have. May 22, 2018 myxedema coma is a rare but severe complication of myxedema. Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. The diagnosis of myxedema coma is initially based upon the history, physical examination, and exclusion of other causes of coma.
Additional symptoms include swelling of the arms and legs and ascites. Bizarre statements abound, such as in myxedema, because of the reduced cardiac output and vasomotor changes, lengthy syncope seems to be common. It is possible that dogs may develop acute hypothyroid crises that respond to iv levothyroxine but do not have myxedema or coma. 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. Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. All patients with an admitting diagnosis of myxedema coma recorded in their charts between january 1, 2005 and june, 2010 were identified. Nov 02, 2016 myxedema coma was first reported by ord in 1879 in london.
Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread. Instead, the diagnostic coding for these patients included. Patients with hypothyroidism may exhibit a number of physiologic alterations to. It is unclear what the optimal levels for serum tsh and thyroid hormones should be in this population. Myxedema coma can be triggered by not taking medicine to treat hypothyroidism. 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. Myxedema coma definition, symptoms, causes, treatment. It is a medical emergency and, even with early diagnosis and treatment, the. Because of a high suspicion of myxedema coma after the clinical examination. Thyroid hormones help control body temperature, heart rate, growth, and weight.
The high mortality rate of 2550 % makes early diagnosis and treatment imperative 1, 2. It is a medical emergency with a high mortality rate. The hallmark presentation of myxoedema coma includes decreased mental status and hypothermia. It is typically caused by a precipitating event in an untreated or partially treated patient. Myxedema coma definition of myxedema coma by medical.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism. Because most atrisk patients, including those with known hypothyroidism, thyroidectomy or previous radioactive iodine therapy, are routinely followed by readily available tsh. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory failure from. Download as ppt, pdf, txt or read online from scribd. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a clinical challenge. Myxedema, strictly speaking, is a boggy swelling of the skin and subcutaneous tissue which results from the deposition of mucin. 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 occurs when thyroid hormone levels are not treated or controlled.
However, despite the ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a challenge. Myxedema coma is a rare syndrome that represents the extreme expression of severe, longstanding hypothyroidism. 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, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult.179 1085 999 446 1421 367 422 806 1064 1605 459 1540 534 1008 574 386 1248 58 9 477 664 508 107 1409 1297 1201 1279 310 1031 203 1208 564 996 1407 1194 651 1328 1098 352 45 619