Myxedema coma history and symptoms

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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]

History

• 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 large part of the tissues. Symptoms of myxedema coma can be summarized in the following table:

Organ system involved	Manifestations
CNS	Lethargy Poor memory Cognitive dysfunction Depression Psychosis Hypothermia Focal or generalized seizures
Cardiovascular	SOB Chest pain Palpitations Orthopnea PND Edema
Pulmonary
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 periorbital level and is responsible for the typical bloated facies.
• It is accompanied by 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, rough 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.