What is myxedema crisis?
Myxedema coma, occasionally called myxedema crisis, is a rare life-threatening clinical condition that represents severe hypothyroidism with physiological decompensation. The condition usually occurs in patients with long-standing, undiagnosed hypothyroidism and is usually precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy. Patients with myxedema coma are generally severely-ill with significant hypothermia and depressed mental status.
What causes Myxedema?
- Physiological stress:
- Infection/ systemic illness
- Cold environmental temperatures
- Trauma
- Burns
- Decreased cerebral blood flow
- Decreased cardiac output
- Congestive heart failure
- Respiratory acidosis
- Drugs
- GI hemorrhage
- Hypoglycemia
- CO2 retention
What are the signs and symptoms?
Hypothermia
• Hypotension/ shock
• Decreased pulse pressure, normal systolic pressure
• Periorbital, nonpitting edema, facial swelling, enlargement of the tonsil, coarse or thinning hairs.
• Thyroid- enlarged, nonpalpable scar
• Lungs- slow respiration rate, hypoventilation, congestion, pleural effusion, consolidation
• diminished apical impulse, bradycardia, enlarged heart, pericardial effusion
• Abdomen- distension secondary to ileus or ascites, diminished or absent bowel sounds
• Bladder distension
• Extremities- cold, nonpitting edema of the hands and feet
• Skin/ Nails- cool, pale, dry, scaly, thickened skin, dry, brittle nails, ecchymosis, purpura, swollen due to carotenemia
• Neuromuscular- confusion, stupor, coma, slow speech, seizures
How do you diagnose?
Total serum thyroxine
Free thyroxine tests usually will confirm the diagnosis.
• Free T4 and TSH: T3, T4 levels are low, TSH may be elevated
Initial laboratory evaluation usually includes a test for thyroid function (TSH, T3 and T4 levels). Other blood tests, as well as heart and lung function testing, may also be needed.
What triggers myxedema?
Some factors may suddenly trigger myxedema coma in a person with poorly controlled hypothyroidism. These include:
drugs (particularly sedatives, narcotics, anesthesia)
• stroke,
• trauma,
• heart failure,
• gastrointestinal bleeding,
• hypothermia (abnormally low body temperature), and
• failing to take thyroid medications as prescribed.
What are the complications?
Adrenal crisis is the major complication.
• hypothermia
• swelling and fluid accumulation
• miscarriage, preeclampsia, stillbirth, and birth defects
• heart failure
• kidney problems
• depression
• coma
• Death
