Myxedema

      

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MYXEDEMA COMA

Myxedema (crisis) coma is a loss of brain function as a result of the severe, longstanding low level of thyroid hormone in the blood (hypothyroidism). Myxedema coma is considered a rare life-threatening complication of hypothyroidism and represents one of the more serious sides of thyroid disease.Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. Patients with hypothyroidism may exhibit a number of physiologic alterations to compensate for the lack of thyroid hormone. If these homeostatic mechanisms are overwhelmed by factors such as infection, the patient may decompensate into myxedema coma. Patients with hypothyroidism typically have a history of fatigue, weight gain, constipation and cold intolerance. Physicians should include hypothyroidism in the differential diagnosis of every patient with hyponatremia. Patients with suspected myxedema coma should be admitted to an intensive care unit for vigorous pulmonary and cardiovascular support. Most authorities recommend treatment with intravenous levothyroxine (T4) as opposed to intravenous liothyronine (T3). Hydrocortisone should be administered until coexisting adrenal insufficiency is ruled out. Family physicians are in an important position to prevent myxedema coma by maintaining a high level of suspicion for hypothyroidism

Symptoms

Myxedema coma occurs when the body can no longer tolerate the effects of hypothyroidism.

When thyroid hormone levels become extremely low, a person may experience the following symptomsTrusted Source:

• confusion or mental slowness
• hypothermia
• decreased breathing
• low blood oxygen levels
• high blood carbon dioxide levels
• lower than usual blood sodium levels
• shock
• seizures
• coma

Treatment

The patient with myxedema coma should be admitted to the intensive care unit, and hypovolemia and electrolyte abnormalities corrected. Mechanical ventilation may be necessary. Cardiovascular status should be monitored carefully, especially after intravenous thyroid hormone replacement. Myocardial infarction must be ruled out and blood pressure stabilized. If possible, pressors and ionotropes should be avoided because of their tendency to provoke arrhythmias in the setting of intravenous thyroid replacement. Patients with hypothermia should be covered with regular blankets; the use of warming blankets should be avoided because the resulting peripheral dilatation may lead to hypotension and cardiovascular collapse.

How is myxedema coma diagnosed?

A doctor can measure T4 and thyroid-stimulating hormone levels to diagnoseTrusted Source myxedema coma.

However, they will likely start with immediate hormone replacement treatment while waiting for the test results based on other symptoms.

These symptoms may include:

• sparse hair
• dry skin
• confusion
• goiter
• a possible scar from thyroid surgery
• hypothermia
• decreased breathing
• swelling, especially in the face and legs

A doctor may perform more tests to determine thyroid function and other conditions that could be affecting the thyroid.