Hypothalamicpituitary myxedema is due to functional and organic changes that interfere with the production of the tshreleasing factor of the hypothalamus or the thyrotropic hormone of the pituitary. This type of myxedema tends to affect skin over the entire body and face. Factors associated with mortality of myxedema coma. Symptoms can manifest in all organ systems and range in severity based on the degree of hormone deficiency. Jordan, md myxedema coma is the most severe expression of hypothyroidism. Myxedema coma myxedema coma myxedema coma carotid artery aneurysm resulting in myxedema coma impending myxedema coma as the initial presentation of lung cancer. Myxedema coma is an endocrinologic emergency and is the most clinically severe form of hypothyroidism.
It occurs from thyroid insufficiency almost seen in elderly subject 3. The assumption is made that physiological aberrations in myxedema coma must be identical with those changes seen in induced hypothermia, since hypothermia often accompanies the former. Primary symptoms of myxedema coma are altered mental status and low body temperature. Myxedema or severe hypothyroidism is clinical condition where the thyroid gland does not produce any thyroid hormone. Myxedema coma symptoms, diagnosis, treatments and causes. Traumatic brain injuries are the most frequent cause. The recognition and management of myxedema coma jama jama. Definitive management is with thyroid hormone but supportive measures, identification and treatment of precipitating factors in an appropriately safe environment are vital. Subhash yadav at sanjay gandhi post graduate institute of medical sciences. Decompensation of the hypothyroid patient into a coma may be precipitated by a number of drugs, systemic illnesses eg, pneumonia, and other causes. A 66yearold white woman was admitted to jewish hospital with a twoday history of abdominal pain, vomiting of bilious material, and. A survey of these reports indicates that 19 out of 25 patients died in spite of vigorous treatment with corticosteroids, vasopressors, thyroid compounds, antibiotics, warming, and electrolyte and fluid correction. 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.
Additional clues to the possible presence of myxedema coma in a poorly responsive patient are the presence of a thyroidectomy scar or a history of radioiodine therapy or hypothyroidism. Absence of mild diastolic hypertension in severely hypothyroid patients is a warning sign of impending myxedema coma. The diagnosis of myxedema coma was made based on the patients clinical presentation and a score of 65 on the diagnostic scoring system published in 2014 by popoveniuc et al. Evaluation of a patient in a coma is comprehensive. A 66yearold white woman was admitted to jewish hospital with a twoday history of abdominal pain, vomiting of bilious material, and diarrhea. Myxedema coma definition of myxedema coma by medical dictionary. It is a medical emergency with a high mortality rate. Myxedema coma in the elderly journal of the american board of. Myxedema coma munir journal of ayub medical college. Prevention requires screening of elderly patients at risk for hypothyroidism and assuring thyroid hormone replacement therapy. Four weeks after admission, she was discharged home on oral levothyroxine 125 gday and continues to do well on this regimen.
Mc should be suspected in pediatric patients with altered mental status, hypothermia and cardiovascular instability. This is really an amazing lifesaving book, its a blessing beyond words. Myxedema coma in a hypothermic, obtunded patient with. Predictors of outcome in myxoedema coma critical care full text. Myxedema wit definition of myxedema wit by the free. An atypical case of myxedema coma with concomitant. The construct of myxedema coma sets clinicians up for diagnostic failure. Signs and symptoms include hypothermia, bradycardia, altered mental status. Myxoedema definition of myxoedema by medical dictionary.
Myxedema crisis can be treated and managed if it is diagnosed early. Hypothyroidism risk factors for death in patients with myxedema coma ono y et al. Decompensated hypothyroidism may be conceptualized as hypothyroidism causing organ failure. A person may have lab values identical to a normal hypothyroid state, but a stressful event such as an infection, myocardial infarction or stroke precipitates the myxedema coma state, usually in the elderly. Myxedema can occur in the lower leg pretibial myxedema and behind the eyes exophthalmos. Myxedema may be the first presentation of patients with undiagnosed hypothyroidism. Myxedema coma or myxedema crisis is a lifethreatening complication of hypothyroidism. Myxedema coma sucipto jurnal kedokteran syiah kuala. It is characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic derangements, including low serum sodium, hypoglycemia, and lactic acidosis. I was very fortunate that i had a brush with this and was successfully resuscitated.
Patients with hypothyroidism may exhibit a number of physiologic alterations to. Myxedema coma definition of myxedema coma by medical. Burman, in clinical management of thyroid disease, 2009. Myxedema, a clinical condition associated with hypothyroidism, refers to thickened, nonpitting edematous changes to soft tissues due to deposition of mucopolysaccharides in the dermis. Diagnostic scoring system for myxedema coma thermoregulatory dysfunction temperature of c points 9535 0 89. 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 wit article about myxedema wit by the free dictionary. Neuromuscular blockers are broken down into 2 main categories, which include depolarizing and nondepolarizing agents. Other readers will always be interested in your opinion of the books youve read. Myxedema coma has also been known to manifest in a number of unusual and dangerous forms. Myxedema psychosis in a patient with undiagnosed hashimoto. Myxedema wit synonyms, myxedema wit pronunciation, myxedema wit translation, english dictionary definition of myxedema wit. Myxedema typically present with a distinct facial appearance, hoarse slow speech, and dryness of the skin. In the last 7 years numerous reports 115 have appeared in the british medical literature dealing with myxedema, shock, and coma. Myxedema coma is a rare, hardtodiagnose condition with a very high mortality rate. Dec 01, 2000 myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. Myxedema coma is the extreme clinical expression of hypothyroidism. May 12, 20 i purchased your ebook, how to reverse diabetes. Most patients, however, are not comatose, and the entity rather represents a form of very severe, decompensated hypothyroidism.
Symptoms of myxedema coma include fever, changes in mental status or behavior, and body swelling. Mar 24, 2020 hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. This case emphasizes the need to consider myxedema coma in the differential diagnosis of profound hypothermia, especially when other clinical. Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma. Choose from 53 different sets of myxedema flashcards on quizlet. Myxedema coma is a state of decompensated hypothyroidism.
A diagnostic scoring system for myxedema coma has been proposed. Myxedema, physiological reaction to lack of sufficient thyroid hormone hypothyroidism in the adult. Patients manifest a marked impairment of central nervous system function and cardiovascular decompensation. Clinical characteristics and outcomes of myxedema coma.
Myxedema skin is almost always caused by an underactive thyroid gland hypothyroidism. Myxedema coma definition, symptoms, causes, treatment. Alternatively, you can download the pdf file directly to your computer, from where it can be opened using a pdf reader. However, despite the ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a challenge. Myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. Arthur schneider, junior assistant resident in medicine, the jewish hospital of st. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread. Myxedema skin is thicker than normal, with a dry waxy coating. There is no consensus about preferred thyroid hormone regimen. Myxedema coma annals of internal medicine american. Here, we present the case of a woman we diagnosed with an uncharacteristic expression of myxedema coma and nonconvulsive seizure complicated by a right middle cerebral artery infarct. Pdf myxedema coma clinical presentation, diagnosis and management find, read and cite all the research you. Aplus compendium ms free ebook download as pdf file. Helpful nursing mnemonics and tips to get you through nursing school.
This form of myxedema may also result from an autoimmune reaction against the bodys own thyroglobulin. A disease caused by decreased activity of the thyroid gland in adults and characterized by dry skin, swellings around the lips and nose. The term myxedema coma is generally seen as misleading since. Some symptoms of myxedema coma include fatigue, lethargy, depression, dry skin, and weight gain. Hypothyroidism and myxedema coma differential diagnoses. Louis, and assistant in medicine, washington university school of medicine. In the child it is known as cretinism cretinism, condition produced in infants and children due to lack of thyroid hormone. Nursing tips nursing notes nursing career lyme disease autoimmune disease lymes disease symptoms adrenal insufficiency symptoms pituitary gland disorders thyroid. Apr 25, 2018 myxedema coma is a rare lifethreatening clinical condition in patients with longstanding severe untreated hypothyroidism, in whom adaptive mechanisms fail to maintain homeostasis. Myxedema coma is a rare, lifethreatening condition, occurs late in the progression of hypothyroidism.
Myxedema psychosis in a patient with undiagnosed hashimoto thyroiditis. Myxoedema coma is a rare and lifethreatening illness the outcome of which has not been robustly studied in large numbers, partly due to its. Our goal is to inform the global em community with timely and high yield content about what providers like you are seeing and doing everyday in your local ed. Having undiagnosed hypothyroid makes you susceptible to anesthesia, narcotics, and sedatives. Myxedema coma is the term given to the most severe presentation of profound hypothyroidism and is often fatal in spite of therapy. Myxedema definition of myxedema by the free dictionary. Myxedema coma clinical presentation, diagnosis and management. Hypothyroidism is a clinical syndrome in which the deficiency or absence of thyroid hormone slows bodily metabolic processes. Three cases of myxedema with terminal coma were described in 1888 by a committee of the clinical society of london.
Myxedema coma, which was first described in the late 1900s as an outcome of longstanding untreated and severe hypothyroidism, has become a rare condition. Ive downloaded your program because my dad has been suffering from diabetes for a very long time but now, thanks to your help, his blood sugar level is well within normal range and all his symptoms are gone. The clinical manifestations of hypothyroidism range from life threateningin the case of myxedema comato no signs or symptoms. In some cases, myxedema condition is also being referred to as underactive thyroid. Myxedema coma endocrine system nursing, medical surgical. 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 and coma severe hypothyroidism endotext ncbi. Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. Whether youve loved the book or not, if you give your honest and detailed thoughts then people will find new books that are right for them. Myxedema coma is defined as severe hypothyroidism leading to decrease mental status, hypothennia, and other symptoms.
The condition is seen typically in elderly women and is often precipitated by infection, medication, environmental exposure, or other metabolicrelated stresses. Pdf raionale myxedema coma mc is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered. The recognition and management of myxedema coma jama. The term myxedema was originally used to describe a special type of skin swelling. There was no previous history of weight gain, cold intolerance, or constipation. Myxedema is known to occur in various forms of hypothyroidism, and also in graves disease. The typical characteristics of myxedema coma, including bradycardia, hypotension, and hypothermia, were absent in this case. Myxedema wit article about myxedema wit by the free. 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. Myxedema definition is severe hypothyroidism characterized by firm inelastic edema, dry skin and hair, and loss of mental and physical vigor. Labs hyponatremia, hypocalcemia, and hypoglycemia, hypotension. Clinical thyroidology for the public volume 10 issue 4 pdf file, 1.