Myxedema coma can be triggered by not taking medicine to treat hypothyroidism. Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Myxedema coma is a severe form of hypothyroidism low thyroid function. Myxedema coma definition, symptoms, causes, treatment. Myxedema is an ailment that is characterized by a thickened and enlarged skin. A diagnostic scoring system for myxedema coma request pdf. Myxedematous coma is a syndrome that results from the intense reduction of the thyroid hormone synthesis. 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. A person may have lab values identical to a normal hypothyroid state, but a stressful event precipitates the myxedema coma state. Pdf myxedema coma clinical presentation, diagnosis and management find, read and cite all the research you need on researchgate.
Although myxedema coma is exceedingly rare with about 200 cases reported between 1953 and 1996 1, and an incidence of about 0. Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma. This is a lifethreatening state that requires immediate medical. Dec 01, 2000 myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. However, a more recent observational study was unable to show significant differences in outcome based on replacement therapeutic methods, with a mortality rate. Myxedema coma is a state of decompensated 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.
Decompensated hypothyroidism myxedema coma emcrit project. Thyroid hormones help control body temperature, heart rate, growth, and weight. 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. As mentioned above, myxedema coma can also present as cardiogenic shock. Combine homeopathy with diet and nutrition of hypothyroidism or myxoedema and get the ultimate treatment for your ailment. The construct of myxedema coma sets clinicians up for diagnostic failure. 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. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory failure from. 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. Low intracellular t3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Hypothyroidism and myxedema coma differential diagnoses. Myxedema definition of myxedema by the free dictionary. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain.
Myxedema crisis can be treated and managed if it is diagnosed early. A case of myxedema coma presenting as a brain stem infarct in a 74yearold korean woman. Predictors of outcome in myxoedema coma critical care full text. Hypothyroidism is a prevalent condition in the general population that is treatable with appropriately dosed thyroid hormone replacement medication. Read and know what is myxedema as well as all about its causes, symptoms, diagnosis and treatment. Myxedema coma definition of myxedema coma by medical. Man with myxedema or severe hypothyroidism showing an expressionless face, puffiness around the eyes and pallor. This is a life threatening condition that is caused by a deficiency in the thyroid gland causing hypothyroidism. Infrequently, patients will present with myxedema coma, characterized by hypothermia, hypotension, bradycardia, and altered mental status in the setting of severe hypothyroidism.
Myxedema can occur in the lower leg pretibial myxedema and behind the eyes exophthalmos. 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. Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. A diagnostic scoring system for myxedema has been proposed based on patients risk of myxedema coma, but its usefulness is limited by the fact that it has been derived from a study involving very. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing. Mar 24, 2020 the mortality rate in myxedema coma has historically been as high as 80%. Some data suggest that aggressive management and early recognition have improved the mortality rate to 1520%. The term myxedema has been applied to several clinical entities and is often used interchangeably with severe hypothyroidism, the common. The condition is prompted by the reduced production of the thyroid hormone by the thyroid gland.
Mar 24, 2020 hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. Myxedema coma due to severelong standing hypothyroidism is a known fatal endocrine emergency but is rare in children. Myxedema and coma severe hypothyroidism endotext ncbi. Myxoedema definition of myxoedema by medical dictionary. Thyroid hormones may be measured every 1 to 2 days. Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death. In some cases, myxedema condition is also being referred to as underactive thyroid. Myxedema coma is primarily a clinical diagnosis with features of uncomplicated hypothyroidism that are more exaggerated. Very rarely do we see patients presenting with the symptoms of myxedema coma.
Additional symptoms include swelling of the arms and legs and ascites. First, lets take a look at hypothyroidism to see what symptoms lead to a patient being in a myxedema coma. Myxoedema coma is a rare and lifethreatening illness the outcome of which has not been robustly studied in large numbers, partly due to its. Sep 15, 2011 myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor.
Amiodarone is a benzofuran derivative that contains 37% iodine by weight and. 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 is a rare skin condition that has a low incidence across the world but can have fatal consequences if left untreated. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. Pdf we report a 14 year old girl who developed myxedema coma, a rare.
Jul 06, 2017 myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive. Here, we focus on cardiovascular complications associated with the condition. Myxedema definition, symptoms, what is, treatment, pictures. 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. 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. Myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates. Myxedema coma is difficult to distinguish from sepsis, and since infection is often the precipitating event in a patient with preexisting hypothyroidism, generally the patients must receive empiric antibiotics until sepsis is ruled out. Myxedema is merely brought about by 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. An atypical case of myxedema coma with concomitant.
Hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. Symptoms can manifest in all organ systems and range in severity based on the degree of hormone deficiency. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread. Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Myxedema coma is an endocrinologic emergency and is the most clinically severe form of hypothyroidism. Myxedema, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult.
Myxedema typically present with a distinct facial appearance, hoarse slow speech, and dryness of the skin. Diastolic hypertension associated with a narrowed pulse pressure is its most described hemodynamic. Myxedema coma with cardiac tamponade and severe cardiomyopathy. Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism. The therapeutic endpoints of levothyroxine therapy in patients with myxedema coma should be improved mental status, improved cardiac function, and improved pulmonary function. Jordan, md myxedema coma is the most severe expression of hypothyroidism. Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling. Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. We report a case of a 5yearold girl transferred to a tertiary care pediatric emergency department with hypoxemia and altered mental status. It is considered a lifethreatening complication of hypothyroidism and represents the far. Myxedema crisis or coma, is a rare and potentially fatal condition caused by low levels of thyroid hormones produced by the thyroid gland. The first thing and definitely the most important one is to have regular followup care and undergo regular blood testing in order to adapt hormone replacement therapy and make changes, if necessary. Myxedema coma has also been known to manifest in a number of unusual. Myxedema coma definition of myxedema coma by medical dictionary.
Childhood cases of myxedema coma are extremely rare. Myxedema or severe hypothyroidism is clinical condition where the thyroid gland does not produce any thyroid hormone. Patients are often placed in the intensive care unit for continuous monitoring and treatment. It is unclear what the optimal levels for serum tsh and thyroid hormones should be in this population. The mortality rates may be as high as 2560% even with best possible treatment 15.
Thoracentesisreverting cardiac tamponade physiology in a. Prevention of myxedema coma because it is known how myxedema coma develops, it is obvious that there are ways to prevent its occurrence. Myxedema coma occurs when thyroid hormone levels are not treated or controlled. It is considered a lifethreatening complication of hypothyroidism and represents the far more serious side of the spectrum of thyroid disease. These adaptations include peripheral vasoconstriction to maintain core body temperature. 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 is an infrequent but potentially fatal complication of hypothyroidism.
Patients manifest a marked impairment of central nervous system function and cardiovascular decompensation. Patients with hypothyroidism may exhibit a number of physiologic alterations to. Feb 03, 2020 myxedema coma is a severe form of hypothyroidism low thyroid function. Myxedema coma treatment, symptoms, causes, diagnosis. We present a rare case of previously undiagnosed hypothyroidism presenting in cardiogenic shock from pericardial tamponade and depressed myocardial contractility in myxedema coma. Myxedema coma discharge care what you need to know. The mortality rate in myxedema coma has historically been as high as 80%. Myxedema article about myxedema by the free dictionary. All patients with an admitting diagnosis of myxedema coma recorded in their charts between january 1, 2005 and june, 2010 were identified. Myxedema is known to occur in various forms of hyperthyroidism, including graves disease. It is mainly caused by a considerable decrease in the level of thyroid hormone in the blood. Decompansated hypothyroidsm myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood hypothyroidism.
It is a medical emergency with a high mortality rate. Myxedema coma is a health condition associated with decreased mental status. Traumatic brain injuries are the most frequent cause. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Evaluation of a patient in a coma is comprehensive. Instead, the diagnostic coding for these patients included.