myxedema

Myxedema is a term generally used to denote severe hypothyroidism, which can occur when the condition is left untreated or not treated sufficiently [1]. It is characterized by a range of symptoms, including dry skin, swelling around the lips and nose, mental deterioration, lethargy, confusion, weakness, and difficulty breathing [9].

Myxedema coma, occasionally called myxedema crisis, is a rare but life-threatening situation caused by untreated hypothyroidism [4]. It can lead to decreased mental status, hypothermia, and other severe symptoms.

The term myxedema describes the “full-blown” expression of acquired hypothyroidism in adults, resembling the effects of cretinism in children [3]. Adult myxedema is a medical condition that requires prompt treatment to prevent serious complications.

Some common manifestations of myxedema include:

• Dry skin
• Swelling around the lips and nose (pretibial myxedema)
• Mental deterioration
• Lethargy
• Confusion
• Weakness
• Difficulty breathing

It is essential to seek medical attention if you or someone you know is experiencing these symptoms, as prompt treatment can help prevent serious complications.

References: [1] - Myxedema is a term generally used to denote severe hypothyroidism. [3] - The term myxedema describes the “full-blown” expression of acquired hypothyroidism. [4] - Myxedema coma, occasionally called myxedema crisis, is a rare but life-threatening situation caused by untreated hypothyroidism. [9] - Result: noun | hypothyroidism marked by dry skin and swellings around lips and nose as well as mental deterioration

Myxedema, also known as severe hypothyroidism, can manifest in various ways, affecting multiple systems in the body. Here are some common signs and symptoms:

• Altered mental status: Myxedema can lead to confusion, apathy, or depression [2].
• Hypothermia: A below-normal body temperature is a hallmark sign of myxedema [1].
• Changes in skin: Pretibial myxedema, a subtype of myxedema, can cause lumps on the skin that may change in size or merge with other lumps [7].
• Cardiovascular symptoms: Decreased pulse pressure, normal systolic pressure, elevated diastolic pressure, and slow pulse are common cardiovascular signs of myxedema [1].
• Respiratory symptoms: Difficulty breathing is a symptom of myxedema coma [3].
• Musculoskeletal symptoms: Muscle pain, joint pain, or leg pain can be associated with myxedema [8].
• Gastrointestinal symptoms: Constipation and decreased sweating are also common in individuals with myxedema [8].

It's essential to note that these symptoms can vary in severity and may not always be present. If you suspect someone has myxedema, it's crucial to seek medical attention promptly.

References: [1] Jan 12, 2024 [2] Feb 2, 2024 [3] Jun 8, 2022 [7] Dec 9, 2022 [8] Apr 22, 2022

Myxedema coma, a life-threatening complication of severe hypothyroidism, can be challenging to diagnose. However, various diagnostic tests can help confirm the condition.

Clinical Diagnosis

While clinical diagnosis is often possible based on characteristic symptoms such as weakness, cold intolerance, mental and physical slowness, dry skin, and hair loss [2], laboratory tests are essential for confirmation.

Laboratory Tests

The following laboratory tests are commonly used to diagnose myxedema coma:

• Thyroid-stimulating hormone (TSH) test: Elevated TSH levels confirm hypothyroidism [4].
• Serum electrolytes and serum osmolality: Hyponatremia with low serum osmolality is common in myxedema coma patients [3].
• Serum creatinine: Usually elevated due to decreased renal function [3].

Imaging Studies

In addition to laboratory tests, imaging studies can help detect associated complications:

• Chest radiography: Can help detect pulmonary infections often associated with myxedema coma [5].
• Acute abdominal series: May reveal an ileus (intestinal paralysis) associated with myxedema coma [5].

Other Diagnostic Tests

A doctor may also recommend the following tests to rule out other conditions:

• Electrocardiogram (ECG): To evaluate heart function and detect any cardiac complications [7].
• Blood tests: To look for signs of infection, kidney problems, or other underlying conditions [7].

References

[1] CR WALL. ELEVATED CREATINE KINASE. Patients with myxedema coma may be mis-diagnosed with myocardial infarction based on elevated CPK levels in ...

[2] WM McConahey. It often is possible to diagnose myxedema on clinical grounds alone. Characteristic symptoms are weakness, cold intolerance, mental and physical slowness, dry skin, and hair loss.

[3] Jan 12, 2024. Other laboratory tests · Serum electrolytes and serum osmolality - Hyponatremia with low serum osmolality is common · Serum creatinine - Usually ...

[4] Apr 4, 2024. Your symptoms will lead your doctor to suspect severe hypothyroidism. Blood tests can help your doctor confirm this. A thyroid-stimulating hormone (TSH) test ...

[5] Apr 22, 2022. A doctor may recommend an electrocardiogram, blood tests to look for signs of infection and kidney problems, and imaging scans of the heart and ...

[6] by DS Ross · Cited by 17 — DIAGNOSIS · When to suspect the diagnosis · Laboratory evaluation · TREATMENT · Supportive measures · Glucocorticoids · Thyroid hormone · - ...

[7] by G Popoveniuc · 2014 · Cited by 125 — The diagnosis of MC is usually based on clinical mani- festations, a history of moderate to severe hypothyroidism, and is confirmed by laboratory testing, with ...

Myxedema, a life-threatening form of hypothyroidism, requires prompt and effective treatment to prevent serious complications and mortality.

Treatment Overview

The primary goal of drug treatment for myxedema is to restore normal thyroid hormone levels in the body. This can be achieved through the administration of synthetic thyroid hormones, specifically levothyroxine (T4) and triiodothyronine (T3).

• Levothyroxine (T4): A synthetic version of the T4 thyroxine hormone, which is used to treat hypothyroidism. This restores T4 levels in the body, helping to alleviate symptoms of myxedema [2].
• Triiodothyronine (T3): Although not commonly used as a first-line treatment for myxedema, T3 can be administered intravenously in severe cases to help restore normal thyroid hormone levels [8].

Additional Treatment Considerations

In addition to thyroid hormone replacement therapy, patients with myxedema may also require:

• Glucocorticoids: Stress doses of glucocorticoids, such as hydrocortisone, are often used to support the patient's adrenal function, which may be impaired in cases of myxedema coma [3].
• Monitoring and Supportive Care: Patients with myxedema crisis require close monitoring of their heart and breathing rates, as well as supportive care in an intensive care unit (ICU) setting [5].

Key Takeaways

In conclusion, the treatment of myxedema involves the administration of synthetic thyroid hormones, such as levothyroxine (T4), to restore normal thyroid hormone levels. Additional considerations include glucocorticoid therapy and close monitoring in an ICU setting.

References:

[1] CR WALL · 2000 · Cited by 218 — THYROID HORMONE REPLACEMENT​​ [2] Apr 22, 2022 — Treatments for myxedema​​ [3] by NG Chamba · 2022 · Cited by 1 — Pituitary–adrenal function may be impaired in myxedema coma... [5] Those undergoing a myxedema crisis need to be treated in an ICU. [8] by CR Wall · 2000 · Cited by 218 — Most authorities recommend treatment with intravenous levothyroxine (T4) as opposed to intravenous liothyronine (T3).

Myxedema coma, also known as severe hypothyroidism, is a life-threatening condition that requires prompt diagnosis and treatment. The differential diagnosis for myxedema coma includes several conditions that can present with similar symptoms.

Key Conditions to Consider:

• Hypothermia: A core body temperature below 95°F (35°C) can be a presenting feature of myxedema coma [1].
• Septic Shock: This condition can also cause hypotension, tachycardia, and altered mental status, making it difficult to distinguish from myxedema coma [3].
• Hepatic Encephalopathy: This condition can present with altered mental status, confusion, and decreased level of consciousness, similar to myxedema coma [1].
• Depression and Suicide: Patients with untreated hypothyroidism may experience depression, which can be a contributing factor to suicidal behavior [4].

Other Conditions to Consider:

• Heart Failure: This condition can cause fatigue, weakness, and shortness of breath, similar to myxedema coma [5].
• Hypoventilation Syndromes: These conditions can lead to respiratory failure, which may be mistaken for myxedema coma [3].

Important Considerations:

• Early Diagnosis and Treatment are Paramount: Myxedema coma is a medical emergency that requires prompt recognition and treatment. Delayed diagnosis can lead to serious complications and even death [7].
• Hypothyroidism should be included in the differential diagnosis of every patient with hyponatremia: This is an important consideration, as patients with suspected myxedema coma may present with hyponatremia [6].

In conclusion, the differential diagnosis for myxedema coma includes several conditions that can present with similar symptoms. A high index of suspicion and prompt recognition are essential for accurate diagnosis and treatment.

References:

[1] Context 1 [3] Context 3 [4] Context 4 [5] Context 5 [6] Context 6 [7] Context 7