Mar 24, 2020 treatment of myxedema coma requires potentially toxic doses of thyroid hormone, and mortality rates exceeding 20% have been reported even with optimum therapy. This section covers recommendations for hospitalized patients with hypothyroidism and use of thyroid hormone analogs. Part iv in a series covering the american thyroid association guideline on the treatment of hypothyroidism. Carlo oller, emergency physician, talks about severe hypothyroidism, or myxedema coma.
Myxedema and coma severe hypothyroidism endotext ncbi. Myxedema coma can be triggered by not taking medicine to treat hypothyroidism. Myxedema may be caused by lack of iodine in the diet. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. The mortality rates may be as high as 25 to 60 percent even with treatment. 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. Currently, one study from the united states has reported a diagnostic scoring system for myxedema coma that is useful for early recognition of the illness. Myxedema coma, also known simply as myxedema, is a rare but potentially deadly manifestation of severe hypothyroidism. Dec 01, 2000 while myxedema coma carries a significant mortality rate even with appropriate testing and treatment, an early diagnosis of hypothyroidism may well save a patients life.
Myxedema typically present with a distinct facial appearance, hoarse slow speech, and dryness of the skin. A case of myxedema coma presenting as a brain stem infarct in a 74yearold korean woman. Elderly people are at a higher risk of having a poor outcome. 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 definition of myxedema by medical dictionary. Myxedema coma with cardiac tamponade and severe cardiomyopathy abdulla majidmoosa, do, jeffrey m. On the other hand, a normal or low serum tsh value in a patient with a low free t4 value indicates central hypothyroidism. Hypothyroidism and myxedema coma differential diagnoses. Myxedema coma mc is defined as an extreme, uncommon and lifethreatening manifestation of hypothyroidism characterized by a marked and general decompensation. 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, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult. The mortality rates may be as high as 2560% even with best possible treatment 15. A history obtained from family members often reveals antecedent symptoms of thyroid dysfunction followed by progressive lethargy, stupor, and coma.
Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. Myxedema coma is a rare, lifethreatening condition, occurs late in the progression of hypothyroidism. Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. Schussler, md, and adan mora, md myxedema coma is an infrequent but potentially fatal complication of hypothyroidism. Diagnosis diagnosis is clinical thyroid panel reflects chronic state 43.
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. It is essential to identify and treat the condition precipitating the coma. Myxedema crisis can be treated and managed if it is diagnosed early. Thyroid hormones help control body temperature, heart rate, growth, and weight. Most patients with myxedema coma have primary hypothyroidism, with high serum tsh and low free t4 values. Myxedema coma is a true endocrine emergency and should be treated aggressively in an intensive care setting. Myxedema definition, symptoms, what is, treatment, pictures. This is a clinical diagnosis and mortality rises with delays in management.
The term myxedema coma is generally seen as misleading since most patients do not. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a clinical challenge. It is typically caused by a precipitating event in an untreated or partially treated patient. The presence of low thyroid hormones such as t3, t4 as well as tsh levels with the presence of the above symptoms are indicative of the condition. As mentioned above, myxedema coma can also present as cardiogenic shock. Recognizing the signs of myxedema and myxedema coma avoids lifethreatening situations. Myxedema coma is a rare but severe complication of myxedema. Myxedema coma symptoms, diagnosis, treatments and causes.
We developed an objective screening tool for myxedema coma to more easily identify patients and examine the best treatment method in future prospective studies to reduce the mortality of this entity. 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. Patients with hypothyroidism may exhibit a number of physiologic alterations to compensate for the lack of thyroid hormone. Myxedema coma is the ultimate stage of severe longstanding hypothyroidism. Though not common, this advanced stage is more life threatening than the earlier stages. Taking their prescribed medication for the disorder helps to prevent myxedema. 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. The typical progression is lethargy evolving into stupor and, eventually, into coma with. Mar 24, 2020 hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. Patients with hypothyroidism may exhibit a number of physiologic alterations to. 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. Feb 03, 2020 myxedema coma is a severe form of hypothyroidism low thyroid function.
The treatment of myxedema coma involves rapid replacement of thyroid hormone, treatment of the precipitating cause, and general supportive measures. In europe, the incidence of coma due to severe thyroid pathologies does not exceed 0. The high mortality rate of 2550 % makes early diagnosis and treatment imperative 1, 2. Symptoms can manifest in all organ systems and range in severity based on the degree of hormone deficiency. It is a lifethreatening complication with a mortality rate of 2560 percent and tends to affect older adults. Myxedema coma occurs when thyroid hormone levels are not treated or controlled. Drugs, such as phenothiazines, amiodarone, lithium, and tranquilizers, and prolonged iodide use. Most people tend to ignore the condition, ruling out its severity, but if the condition remains untreated for long time it might become deadly. We present a rare case of previously undiagnosed hypothyroidism presenting in cardiogenic shock from pericardial tamponade. A swift diagnosis can be critical to a patients prognosis.
Long periods of low thyroid hormones may lead to a fatal condition known as myxedema coma. Myxedema or severe hypothyroidism is clinical condition where the thyroid gland does not produce any thyroid hormone. Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. A stated, despite a prompt diagnosis and initiation of treatment, mortality from myxedema coma can still exceed 30%. Because it is known how myxedema coma develops, it is obvious that there are ways to prevent its occurrence. The condition is seen typically in elderly women and is often precipitated by infection, medication, environmental exposure, or other metabolicrelated stresses.
May 31, 2017 myxedema coma is the most severe manifestation of hypothyroidism. Cases of myxedema coma usually occur in women with a significant mortality rate 2560% even when they are under proper treatment 2,3. The diagnosis of myxedema coma is made by testing for thyroid hormones and observing the symptoms. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than. Myxedema symptoms, diagnosis, treatments and causes. Development of an objective tool for the diagnosis of. A diagnostic scoring system for myxedema coma request pdf. An atypical case of myxedema coma with concomitant. If these homeostatic mechanisms are overwhelmed by factors such as infection. Welcome to journal of the association of physicians of india. In some cases, myxedema condition is also being referred to as underactive thyroid. To avoid myxedema or myxedema coma, patients with hypothyroidism need treatment for their underactive thyroid as early as possible, especially when noticing symptoms. Myxedema coma discharge care what you need to know.
Myxedema coma, a rare entity, with a reported 25%65% mortality had no objective criteria for making the diagnosis when we began our study. Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling. Myxedema coma can be prevented with early treatment of hypothyroidism, taking thyroid medication regularly, and recognition of the warning symptoms of myxedema coma. 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 is a severe form of hypothyroidism low thyroid function. C, d nonpitting edema and desquamation of the hands and feet. Along with the signs and symptoms of severe hypothyroidism, symptoms of myxedema crisis can include.
Myxedema coma definition, symptoms, causes, treatment. Because most atrisk patients, including those with known hypothyroidism, thyroidectomy or previous radioactive iodine therapy, are routinely followed by readily available tsh assay. Primary treatment is prompted by the administration of adequate doses of either the thyroid hormone lthyroxine given intravenously or by giving liothyronine via a nasogastric tube. Myxedema information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. If you have severe hypothyroidism, then any of the following can contribute to myxedema coma. Myxedema coma as a t rue medical emergency requires a multifaceted approach to treatment in a critical care setting treatment should be instituted in patients with presumed myxedema coma. A complication of myxedema in the form of myxedema coma in two thirds of cases develops in women whose average age is 7075 years. 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 coma with cardiac tamponade and severe cardiomyopathy. It is important to suspect myxedema coma in patients with a history of hypothyroidism presenting with altered mental status after a known precipitating event and to begin empiric treatment with large doses of synthetic t4 200400 mcg and t3 promptly to avoid complications. Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Myxedema coma treatment, symptoms, causes, diagnosis. It is usually accompanied by a subnormal temperature. Jul 06, 2017 without a rapid diagnosis, myxedema crisis is often fatal.