Myxedema coma history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The function of all [[organ systems]] and various [[metabolic pathways]] are compromised in [[hypothyroidism]]. The cardinal symptoms of myxedema coma are the sensory impairment and [[hypothermia]]. The accumulation in the interstitial tissue of [[mucopolysaccharides]] and water leads to [[myxedema]] that compromises a large part of the tissues. [[Myxedema]] coma patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. | |||
==History== | ==History== | ||
* History of thyroid disease | Obtaining a [[History and Physical examination|history]] gives important information in making a [[diagnosis]] of myxedema coma. It provides an insight into the cause, precipitating factors, and associated [[comorbid]] conditions. A complete [[History and Physical examination|history]] will help determine the correct [[therapy]] and helps in determining the [[prognosis]]. Myxedema coma patients may be [[Disorientation|disoriented]], therefore, the [[patient]] interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be on the onset, duration, and progression of [[symptoms]] such as: | ||
* History of radioiodine therapy or thyroidectomy | * History of [[thyroid]] disease | ||
* Thyroid hormone therapy that was inappropriately discontinued | * History of [[radioiodine]] therapy or [[thyroidectomy]] | ||
*[[Thyroid hormone]] therapy that was inappropriately discontinued | |||
==Symptoms== | ==Symptoms== | ||
Symptoms of myxedema coma can be summarized in the following table:<ref name="pmid17127141">{{cite journal |vauthors=Wartofsky L |title=Myxedema coma |journal=Endocrinol. Metab. Clin. North Am. |volume=35 |issue=4 |pages=687–98, vii–viii |year=2006 |pmid=17127141 |doi=10.1016/j.ecl.2006.09.003 |url=}}</ref> | The function of all organ systems and various metabolic pathways are compromised in [[hypothyroidism]]. The cardinal symptoms of myxedema coma are the sensory impairment and [[hypothermia]]. The accumulation in the [[interstitial]] tissue of [[mucopolysaccharides]] and water leads to [[myxedema]] that compromises a large part of the tissues. Symptoms of [[myxedema]] coma can be summarized in the following table:<ref name="pmid17127141">{{cite journal |vauthors=Wartofsky L |title=Myxedema coma |journal=Endocrinol. Metab. Clin. North Am. |volume=35 |issue=4 |pages=687–98, vii–viii |year=2006 |pmid=17127141 |doi=10.1016/j.ecl.2006.09.003 |url=}}</ref><ref name="pmid28825577">{{cite journal |vauthors=Rizzo LFL, Mana DL, Bruno OD, Wartofsky L |title=[Myxedema coma] |language=Spanish; Castilian |journal=Medicina (B Aires) |volume=77 |issue=4 |pages=321–328 |year=2017 |pmid=28825577 |doi= |url=}}</ref><ref name="pmid28825577">{{cite journal |vauthors=Rizzo LFL, Mana DL, Bruno OD, Wartofsky L |title=[Myxedema coma] |language=Spanish; Castilian |journal=Medicina (B Aires) |volume=77 |issue=4 |pages=321–328 |year=2017 |pmid=28825577 |doi= |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
!Organ system involved | !Organ system involved | ||
!Manifestations | !Manifestations | ||
|- | |- | ||
![[CNS]] | |||
| | | | ||
* Lethargy | * [[Lethargy]] | ||
* | * [[Memory loss]] | ||
* Cognitive dysfunction | * [[Cognitive]] dysfunction | ||
* Depression | * [[Depression]] | ||
* [[Psychosis]] | |||
* [[Hypothermia]] | |||
* [[Seizures|Focal or generalized seizures]] | |||
|- | |||
![[Cardiovascular]] | |||
| rowspan="2" | | |||
* [[Shortness of breath]] | |||
* [[Chest pain]] | |||
* [[Palpitations]] | |||
* [[Orthopnea]] | |||
* [[PND]] | |||
* [[Edema]] | |||
|- | |- | ||
![[Pulmonary]] | |||
|- | |- | ||
| | ![[Gastro-intestinal tract|Gastro-intestinal]] | ||
| | |||
* [[Anorexia]] | |||
* [[Nausea]] | |||
* [[Abdominal pain]] | |||
* [[Constipation]] | |||
|- | |- | ||
![[Renal]] and [[electrolyte]] | |||
| | | | ||
* | * [[Bladder]] [[atony]] with [[urinary retention]] | ||
|- | |- | ||
![[Systemic]] | |||
| | | | ||
* | *[[Sweats]] | ||
*[[Anorexia]] | |||
*[[Weakness]] | |||
*[[Sleep disturbances]] | |||
|- | |- | ||
| | ![[Skin]] | ||
| | |||
*Dryness | |||
*[[Rash]] | |||
*[[Perspiration]] | |||
|} | |} | ||
===Myxedema=== | |||
*Myxedema is a defined as deposition of [[mucopolysaccharides]] in the [[dermis]] at the periorbital level and is responsible for the typical bloated facies. | |||
*It is accompanied by a thin, dry and brittle hair and even [[alopecia]], loss of the tail of the [[eyebrows]] (sign of Queen Anne or supraciliar madarosis) and [[macroglossia]], with cold skin (by reflex cutaneous [[vasoconstriction]]), pale-yellowish (from [[anemia]] and hypercarotinemia), dry and rough (elephant skin). | |||
===Hypothermia=== | |||
*It is defined by the presence of core body temperature ([[rectal]]) <35 ° C, although in general it is serious, with records between 26 ° C and 32 ° C. | |||
*It is noted in most cases of [[myxedema coma]], and due to a decrease in [[thermogenesis]] accompanying the decline of [[metabolism]]. | |||
*[[Hypoglycemia]] also complicates [[hypothermia]]. | |||
*There is a correlation between the degree of [[hypothermia]] and survival, with a worse [[prognosis]] for those with temperatures below 32 °. | |||
*Occasionally, [[hypothermia]] may be absent in presence of serious infections. Thus, the diagnosis must be seriously considered in every afebrile patient with a serious underlying [[infection]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 00:47, 26 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
The function of all organ systems and various metabolic pathways are compromised in hypothyroidism. The cardinal symptoms of myxedema coma are the sensory impairment and hypothermia. The accumulation in the interstitial tissue of mucopolysaccharides and water leads to myxedema that compromises a large part of the tissues. Myxedema coma patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained.
History
Obtaining a history gives important information in making a diagnosis of myxedema coma. It provides an insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and helps in determining the prognosis. Myxedema coma patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be on the onset, duration, and progression of symptoms such as:
- History of thyroid disease
- History of radioiodine therapy or thyroidectomy
- Thyroid hormone therapy that was inappropriately discontinued
Symptoms
The function of all organ systems and various metabolic pathways are compromised in hypothyroidism. The cardinal symptoms of myxedema coma are the sensory impairment and hypothermia. The accumulation in the interstitial tissue of mucopolysaccharides and water leads to myxedema that compromises a large part of the tissues. Symptoms of myxedema coma can be summarized in the following table:[1][2][2]
| Organ system involved | Manifestations |
|---|---|
| CNS | |
| Cardiovascular | |
| Pulmonary | |
| Gastro-intestinal | |
| Renal and electrolyte | |
| Systemic | |
| Skin |
|
Myxedema
- Myxedema is a defined as deposition of mucopolysaccharides in the dermis at the periorbital level and is responsible for the typical bloated facies.
- It is accompanied by a thin, dry and brittle hair and even alopecia, loss of the tail of the eyebrows (sign of Queen Anne or supraciliar madarosis) and macroglossia, with cold skin (by reflex cutaneous vasoconstriction), pale-yellowish (from anemia and hypercarotinemia), dry and rough (elephant skin).
Hypothermia
- It is defined by the presence of core body temperature (rectal) <35 ° C, although in general it is serious, with records between 26 ° C and 32 ° C.
- It is noted in most cases of myxedema coma, and due to a decrease in thermogenesis accompanying the decline of metabolism.
- Hypoglycemia also complicates hypothermia.
- There is a correlation between the degree of hypothermia and survival, with a worse prognosis for those with temperatures below 32 °.
- Occasionally, hypothermia may be absent in presence of serious infections. Thus, the diagnosis must be seriously considered in every afebrile patient with a serious underlying infection.
References
- ↑ Wartofsky L (2006). "Myxedema coma". Endocrinol. Metab. Clin. North Am. 35 (4): 687–98, vii–viii. doi:10.1016/j.ecl.2006.09.003. PMID 17127141.
- ↑ 2.0 2.1 Rizzo L, Mana DL, Bruno OD, Wartofsky L (2017). "[Myxedema coma]". Medicina (B Aires) (in Spanish; Castilian). 77 (4): 321–328. PMID 28825577. Vancouver style error: initials (help)