Myxedema is the most severe form of hypothyroidism and may result in death. 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 coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in. A case of myxedema coma presenting as a brain stem infarct in a 74yearold korean woman. Jul 06, 2017 myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates. Myxedema, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult. Here, we present the case of a woman we diagnosed with an uncharacteristic expression of myxedema coma and nonconvulsive seizure complicated by a right middle cerebral artery infarct. Myxedema is known to occur in various forms of hypothyroidism, and also in graves disease. Myxedema coma mc is defined as an extreme, uncommon and lifethreatening manifestation of hypothyroidism characterized by a marked and general decompensation. 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. Burman, in clinical management of thyroid disease, 2009. Myxoedema coma is a rare, almost forgotten, yet still existing, endstage manifestation of longlasting hypothyroidism, affecting most of the organs, and in severe cases leading to multiorgan failure.
Decompensated hypothyroidism may be conceptualized as hypothyroidism causing organ failure. Myxedema coma is an endocrinologic emergency and is the most clinically severe form of hypothyroidism. Myxedema coma definition, symptoms, causes, treatment. Myxedema coma occurs when thyroid hormone levels are not treated or controlled. 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.
Patients with hypothyroidism may exhibit a number of physiologic alterations to. Myxedema coma mc is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental status and hypothermia. 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. Myxedema coma myxedema coma myxedema coma carotid artery aneurysm resulting in myxedema coma impending myxedema coma as the initial presentation of lung cancer. Pdf raionale myxedema coma mc is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental. Thyroid hormones help control body temperature, heart rate, growth, and weight. Myxoedema coma occurs almost exclusively in patients over 60 years of age. Myxedema coma present as a normal hypothyroidism based on laboratory tests, but other serious conditions can trigger the development of the state. Myxedema coma due to severelong standing hypothyroidism is a known fatal endocrine emergency but is rare in children and unreported in pediatric down syndrome. Myxedema definition of myxedema by the free dictionary. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than.
To develop diagnostic criteria for myxedema coma mc, a decompensated state of extreme hypothyroidism with a high mortality rate if untreated, in order to facilitate its early recognition and treatment. Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism. It is characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic derangements, including low serum sodium, hypoglycemia, and lactic acidosis. Decompansated hypothyroidsm mortality rate in myxedema coma has historically been as high as 80% disease appears more often in white and hispanic populations greater in females than males femaletomale ratio 510. Myxedema coma precipitated by diabetic ketoacidosis after total. Myxedema coma annals of internal medicine american. Hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. Myxoedema coma, the extreme manifestation of hypothyroidism, is exceedingly rare due to the widespread availability of thyroidstimulating hormone assay. The frequencies of characteristics associated with mc were assessed retrospectively in patients from our institutions in order to derive a semiquantitative. An atypical case of myxedema coma with concomitant. The typical characteristics of myxedema coma, including bradycardia, hypotension, and hypothermia, were absent in this case.
Myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates. Few cases are reported in the literature, yet they all agree on the severity of this condition and report a mortality of 30% to 60%. Myxedema coma abstract myxedema coma is the most extreme manifestation of hypothyroidism, a condition being rare but potentially lethal. Mar 24, 2020 hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. The hallmark presentation of myxoedema coma includes decreased mental status and hypothermia. Currently, the initial thyroid hormone replacement of intravenous lthyroxine lt4 is regarded as the standard therapy for myxedema coma induced by long. Lippincott nursingcenter nursing pocket card thyroid. Myxedema coma is a severe, lifethreatening emergency that can occur in longstanding, untreated hypothyroidism. An eightynineyearold female with a history of hypothyroidism and hypertension presented from a nursing home with lethargy, bradycardia, and hypothermia. Predictors of outcome in myxoedema coma critical care full text.
Decompensated hypothyroidism myxedema coma emcrit project. The mortality rates may be as high as 2560% even with best possible treatment 15. Apr 16, 2014 myxoedema coma is around four times more common in women than in men reflecting the higher incidence of hypothyroidism in women, which has a prevalence of 8% in women aged over 50. Treatment should be initiated on the basis of clinical suspicion without waiting for laboratory results. If not recognised, however, in time it may develop into the most severe manifestation of hypothyroidism known as myxedema coma. Sep 15, 2011 myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Primary symptoms of myxedema coma are altered mental status and low body temperature.
Article information, pdf download for myxedema coma, open epub for myxedema coma. Patients are typically elderly women who present in winter with deteriorating mental status, hypothermia, bradycardia, and multisystem organ failure. Patients are often placed in the intensive care unit for continuous monitoring and treatment. Diagnosis is based on laboratory results consistent with hypothyroidism and corresponding clinical manifestations. Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Identifying and treating thyroid storm and myxedema coma in the emergency department. Myxedema crisis can be treated and managed if it is diagnosed early. Treatment should be started quickly given the increased risk of mortality. Myxedema can occur in the lower leg pretibial myxedema and behind the eyes exophthalmos.
Myxedema coma is a state of decompensated hypothyroidism. 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. Myxoedema coma is a rare lifethreatening disease, and it is essential that it is managed appropriately to reduce the associated high mortality. Most patients, however, are not comatose, and the entity rather represents a form. Symptoms can manifest in all organ systems and range in severity based on the degree of hormone deficiency. Myxedematous coma is a syndrome that results from the intense reduction of the thyroid hormone synthesis. Myxoedema coma is a rare and lifethreatening illness the outcome of which has not been robustly studied in large numbers, partly due to its. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Myxedema coma has also been known to manifest in a number of unusual and dangerous forms. Dec 01, 2000 myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death.
Patients with undertreated or untreated hypothyroidism have no metabolic reserve. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a clinical challenge. The frequencies of characteristics associated with mc were assessed retrospectively in patients from our institutions in order to derive a semiquantitative diagnostic point. Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. Although most dogs in a hypothyroid crisis have mental dullness, coma upon initial examination is uncommon. Myxedema coma can be triggered by not taking medicine to treat hypothyroidism. Myxedema coma journal of intensive care medicine sage. 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. Hypothyroidism and myxedema coma pediatric em morsels.
In the last 7 years numerous reports 115 have appeared in the british medical literature dealing with myxedema, shock, and coma. Challenges in the management of a patient with myxoedema coma. Untreated or unrecognized hypothyroidism may progress to severe decompensated hypothyroidism or myxedema coma. However, despite the ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a challenge. Myxedema coma treatment, symptoms, causes, diagnosis. The diagnosis of myxedema coma was made based on the patients clinical presentation and a score of 65 on the diagnostic scoring system published in 2014 by popoveniuc et al. Practice recommendations key points from the issue. She was oriented to self only, minimally verbal requiring assistance for activities of daily life at baseline. The construct of myxedema coma sets clinicians up for diagnostic failure. Most patients dont have nonpitting edema myxedema, nor are they frankly comatose.
Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. Pdf myxedema coma clinical presentation, diagnosis and management find, read and cite all the research you. Myxedema coma is the most severe form of hypothyroidism and carries a high mortality risk. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive. Thyroid storm and myxedema coma in the emergency department. Three cases of myxedema with terminal coma were described in 1888 by a committee of the clinical society of london. Important clues to the possible presence of myxedema coma in a poorly responsive patient are the presence of a thyroidectomy scar or a history of radioiodine therapy or.
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. Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma. Aggressive therapy is required to avoid a fatal outcome. Myxedema coma is the most severe manifestation of hypothyroidism. Clinical characteristics and outcomes of myxedema coma. It is an endocrine emergency associated with a high mortality rate. 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. Mortality reported for myxedema coma between 3060%. A diagnostic scoring system for myxedema coma johns. A person may have lab values identical to a normal hypothyroid state, but a stressful event precipitates the myxedema coma state. The condition results from severe and persistent low thyroid hormones that cause loss of brain function. Myxedema coma is a rare, but severe form of hypothyroidism with a high mortality rate. Signs and symptoms include hypothermia, bradycardia, altered mental status, hypotension, and eventual respiratory. May go unrecognized in young patients people yet still existing cause of multiorgan failure.
The best way to think about this disease is simply decompensated hypothyroidism. Myxedema coma is the extreme clinical expression of hypothyroidism. Early recognition and therapy of myxedema coma are essential. Bizarre statements abound, such as in myxedema, because of the reduced cardiac output and vasomotor changes, lengthy syncope seems to be common. Signs and symptoms include hypothermia, bradycardia, altered mental status. A diagnostic scoring system for myxedema coma johns hopkins. C, d nonpitting edema and desquamation of the hands and feet. This is a lifethreatening state that requires immediate medical.
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