Myxedema coma (patient information)

Myxedema coma
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Myxedema coma?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Myxedema coma constitutes the highest expression of untreated hypothyroidism and results from depletion severe and prolonged thyroid hormones. The term coma is considered to be misleading because the majority of patients with this syndrome are not initially in a comatose condition.

What are the Symptoms of myxedema coma?

When thyroid hormone levels are too low, the body’s cells can’t get enough thyroid hormone and the body’s processes start slowing down. As the body slows, you may notice that you feel colder, you tire more easily, your skin is getting drier, you’re becoming forgetful and depressed, and you’ve started getting constipated. Because the symptoms are so variable and nonspecific, the only way to know for sure whether you have hypothyroidism is with a simple blood test for TSH.

What Causes myxedema coma?

Common causes of myxedema coma include sepsis, exposure to cold weather, central nervous system depressants (sedatives, narcotics, antidepressants), trauma, surgery, stroke, congestive heart failure, burns, intravascular volume contraction (GI blood loss, diuretic use), myocardial infarction, and metabolic derangements.

Who is at Highest Risk?

Common risk factors in the development of myxedema coma include:

• Hypothermia
• Cerebrovascular accidents
• Congestive heart failure
• Infections
• Drugs
  • Anesthetics
  • Narcotics
  • Amiodarone
  • Lithium carbonate
• Gastrointestinal bleeding
• Trauma
• Metabolic disturbances
  • Hypoglycemia
  • Hyponatremia
  • Acidosis
  • Hypercalcemia
  • Hypoxemia
  • Hypercapnia

Diagnosis

The correct diagnosis of myxedema coma depends on the following:

• Symptoms
• Medical and family history. You should tell your doctor about
  • Changes in your health that suggest that your body is slowing down;
  • If you’ve ever had thyroid surgery;
  • If you’ve ever had radiation to your neck to treat cancer
• Physical exam
  • The doctor will check your thyroid gland and look for changes such as dry skin, swelling, slower reflexes, and a slower heart rate.
• Blood tests. There are two blood tests that are used in the diagnosis of hypothyroidism.
  • TSH (thyroid-stimulating hormone) test. This is the most important and sensitive test for hypothyroidism. It measures how much of the thyroid hormone thyroxine (T4) the thyroid gland is being asked to make. An abnormally high TSH means hypothyroidism: the thyroid gland is being asked to make more T4 because there isn’t enough T4 in the blood.
  • T4 tests. Most of the T4 in the blood is attached to a protein called thyroxine-binding globulin. The “bound” T4 can’t get into body cells. Only about 1%–2% of T4 in the blood is unattached (“free”) and can get into cells.
  • The free T4 and the free T4 index are both simple blood tests that measure how much unattached T4 is in the blood and available to get into cells.

When to Seek Urgent Medical Care?

Call your health care provider if:

• You develop symptoms of hypothyroidism
• You have hypothyrodidism and the symptoms continue despite treatment

Treatment Options

Taking medications for hypothyroidism can prevent progression of untreated hypothyroidism into myxedema coma.

Where to find Medical Care for Myxedema coma?

Medical care for (disease name) can be found here.

Prevention

Taking medications for hypothyroidism can prevent progression of untreated hypothyroidism into myxedema coma.

What to Expect (Outlook/Prognosis)?

The mortality rate in myxedema coma is 20% to 25% despite aggressive therapy.

Possible Complications

Common complications of myxedema coma include:

• Treatment-induced congestive heart failure in patients with coronary artery disease
• Increased susceptibility to infection
• Organic psychosis with paranoia
• Adrenal crisis with vigorous treatment of hypothyroidism
• Hypersensitivity to opiates
• Pericardial effusion
• Cardiac tamponade

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm