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. Thyroid hormones may be measured every 1 to 2 days. Guidelines american association of clinical endocrinologists. Diagnosis of myxedema coma complicated by renal failure. Thyroidectomy scar in patients with altered mental status, suggests myxedema coma as a potential cause a swedish study, by mourtzinis et al, found the rates of hypothyroidism and hyperthyroidism in patients with atrial fibrillation to be 5. These adaptations include peripheral vasoconstriction to maintain core body temperature. Myxedema definition of myxedema by the free dictionary. Because most atrisk patients, including those with known hypothyroidism, thyroidectomy or previous radioactive iodine therapy, are routinely. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in. Aace protocol for standardized production of clinical practice guidelines, algorithms, and checklists 2017 update clinical practice guideline cpg, clinical practice algorithm cpa, and clinical checklist cc, collectively cpgac development is a high priority of the american association of clinical endocrinologists aace and american. Myxedema coma occurs most often in the elderly and during the winter months. Treatment of myxedema coma usually involves emergency measures to reverse the condition and prevent death.
How we measure reads a read is counted each time someone views a publication summary such. It traditionally occurs in hypothyroid states, and recognition of this generalized nonpitting edema provides the physician with a reason to suspect hypothyroidism. 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. Analysis of a national inpatient database in japan. Clinical endocrinologists worldwide rely on endocrine practice, the official journal of the american association of clinical endocrinologists aace, to keep them on the leading edge of treatment of patients with endocrine diseases. Myxedema coma treatment, symptoms, causes, diagnosis.
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%. Hypothyroidism and myxedema coma pediatric em morsels. May 31, 2017 myxedema coma is the most severe manifestation of hypothyroidism. Few cases are reported in the literature, yet they all agree on the severity of this. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded.
Jul 06, 2017 myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates. 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. Sigmoid volvulus in myxedema megacolon aace clinical case. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. 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. Myxedema crisis can be treated and managed if it is diagnosed early. Ono y, ono s, yasunaga h, matsui h, fushimi k, tanaka y. It is a medical emergency with a high mortality rate. Additional symptoms include swelling of the arms and legs and ascites.
Very rarely do we see patients presenting with the symptoms of myxedema coma. 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 may be part of the natural progression of hypothyroidism or may be triggered in patients with chronic hypothyroidism by conditions such as drug overdose, myocardial infarction, cerebral infarction, injury, or cold exposure with previously existing. Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma. What is the role of glucocorticoid therapy in the treatment. Keywords case report, diagnosis, emergency, myxedema coma, renal failure. Myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor. Clinical characteristics and outcomes of myxedema coma. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain.
Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. Myxedema, strictly speaking, is a boggy swelling of the skin and subcutaneous tissue which results from the deposition of mucin. Sigmoid volvulus in myxedema megacolon aace clinical. Among myxedema coma patients, older age and catecholamine use are associated with higher risk for inhospital mortality elizabeth n. Summary of the study patients with myxedema coma were identified in national inpatient database by diagnostic codes used by. It is a rare disorder, with only approximately 300 cases described in the literature typically elderly females have longstanding, undiagnosed hypothyroidism more than 90% of.
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. Myxedema coma due to severelong standing hypothyroidism is a known fatal endocrine emergency but is rare in children and unreported in pediatric down syndrome. Hypothyroidisminduced stercoral sigmoid colonic perforation. The spectrum of hypothyroidism ranges from an asymptomatic, subclinical condition to the rare lifethreatening myxedema coma, and thus can be a challenging diagnosis to make. This is a life threatening condition that is caused by a deficiency in the thyroid gland causing hypothyroidism. Hypothyroidism is a common condition of thyroid hormone deficiency, which is readily diagnosed and managed but potentially fatal in severe cases if untreated. Myxedema coma abstract myxedema coma is the most extreme manifestation of hypothyroidism, a condition being rare but potentially lethal. Typical symptoms include fatigue, weight gain, constipation, and cold and heat intolerance. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread. Myxedema coma is preceded by a long history of hypothyroidismrelated symptoms, such as generalized fatigue, cold intolerance, constipation, and dry skin, which slowly progress into more pronounced clinical manifestations such as lethargy, delirium, and coma. Nevertheless, although the need to treat these patients with thyroid hormone is so patently obvious, the regimen by which to conduct this treatment remains somewhat controversial. Pdf raionale myxedema coma mc is extremely rare but lethal in pediatric patients with hypothyroidism. The therapeutic endpoints of levothyroxine therapy in patients with myxedema coma should be improved mental status, improved cardiac function, and improved pulmonary function. Myxedema and coma severe hypothyroidism endotext ncbi.
We report 2 patients who presented with clinical symptoms of acute upper airway obstruction from presumed supraglottic myxedema and compare their clinical presentation, diagnosis, and management with previously reported cases. List the hormones produced by the adrenal glands 11. Myxedema coma, an emergency presentation of hypothyroidism, is wellknown to be a lifethreatening condition. Treatment for myxedema coma includes supportive care with ventilatory support and pressor support if necessary. Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. This is a lifethreatening state that requires immediate medical. Myxedema coma definition, symptoms, causes, treatment. Internationally respected endocrine practice is the journal for clinical endocrinologists. A case of myxedema coma presenting as a brain stem infarct in a 74yearold korean woman. Factors associated with mortality of myxedema coma. In spite of ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a clinical challenge. Mar 24, 2020 thyroidectomy scar in patients with altered mental status, suggests myxedema coma as a potential cause a swedish study, by mourtzinis et al, found the rates of hypothyroidism and hyperthyroidism in patients with atrial fibrillation to be 5. Hypothyroidism risk factors for death in patients with myxedema coma ono y et al.
May go unrecognized in young patients people 2017 occurs in patients with severe hypothyroidism. Mortality reported for myxedema coma between 3060%. The term myxedema coma is a misnomer, and myxedema crisis may be an apt term as quite a few patients are obtunded, rather than. Man with myxedema or severe hypothyroidism showing an expressionless face, puffiness around the eyes and pallor. He was eventually found to be in myxedema coma in light of evolving signs and laboratory. Myxedematous coma is a syndrome that results from the intense reduction of the thyroid hormone synthesis. Sep 15, 2011 myxedema coma is a severe and lifethreatening form of decompensated hypothyroidism with an underlying precipitating factor.
Myxedema coma was first reported by ord in 1879 in london. 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. However, the term is also used to describe a dermatological change that can occur in hyperthyroidism and rare paradoxical cases of hypothyroidism. Childhood cases of myxedema coma are extremely rare. Primary symptoms of myxedema coma are altered mental status and low body temperature. Nov 02, 2016 myxedema coma was first reported by ord in 1879 in london.
In this latter sense, myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. Myxedema coma, which was first described in the late 1900s as an outcome of long standing untreated and severe hypothyroidism, has become a rare condition. 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 coma and severe hypothyroidism the clinical manifestations of hypothyroidism range from life threateningin the case of myxedema comato no signs or symptoms. First, lets take a look at hypothyroidism to see what symptoms lead to a patient being in a myxedema coma. Risk factors for death in patients with myxedema coma american. We report a case of a 5yearold girl transferred to a tertiary care pediatric emergency department with hypoxemia and altered mental status. Clinical manifestations of hypothyroidism range from life threatening to no.
Mar 24, 2020 ono y, ono s, yasunaga h, matsui h, fushimi k, tanaka y. Dec 01, 2000 myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. The definition of hypothyroidism is based on statistical reference ranges of the relevant biochemical parameters and is increasingly a matter of debate. Myxedema crisis occurs when your body can no longer tolerate the changes caused by severe hypothyroidism, so it decompensates. Myxedema is a term used synonymously with severe hypothyroidism. Patients with hypothyroidism may exhibit a number of physiologic alterations to. Patients should be given iv hydrocortisone, 100 mg, to treat possible adrenal insufficiency and t 4, 4 mcgkg by slow iv infusion. It is unclear what the optimal levels for serum tsh and thyroid hormones should be in this population. Myxedema coma is usually caused by a precipitating event in the untreated, or partially treated, hypothyroid patient. Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling. The question is how to restore the low serum and tissue thyroid hormone concentrations to.
In patients with myxedema coma, an effective approach consists of the following. Myxedema coma is a rare lifethreatening clinical condition in patients with. It is a rare disorder, with only approximately 300 cases described in the literature typically elderly females have longstanding, undiagnosed hypothyroidism more than 90% of cases occur during winter months 5. Myxedema is known to occur in various forms of hyperthyroidism, including graves disease. Hypothyroidism and myxedema coma differential diagnoses. It can occur as the culmination of severe, longstanding. It is typically caused by a precipitating event in an untreated or partially treated patient. The mortality rates may be as high as 2560% even with best possible treatment 15.
Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. The high mortality rate of 2550 % makes early diagnosis and treatment imperative 1, 2. We report a case of a 5yearold girl transferred to a tertiary care pediatric emergency department. Hypothyroidism has been associated with a variety of gastrointestinal gi manifestations, such as hypomotility, atony, abdominal distention, pseudoobstruction, and. Myxedema coma, also known simply as myxedema, is a rare but potentially deadly manifestation of severe hypothyroidism. Patients are often placed in the intensive care unit for continuous monitoring and treatment. The prognosis, however, remains poor with a reported mortality between 20% and 50%. This progression is usually accelerated by the triggers mentioned above, like heart failure, trauma, or infection. Challenges in the management of a patient with myxoedema coma. Describe 5 key clinical features of myxedema coma and list 8 precipitating factors 9.