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Definition

What is myxedema coma?

Myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood (hypothyroidism). Myxedema coma is considered a life-threatening complication of hypothyroidism and represents the far more serious side of the spectrum of thyroid disease.

How common is myxedema coma?

Myxedema coma is not common, but tends to be seen more frequently in elderly patients and in women. There is an increased incidence in the winter months, which is likely secondary to the extremes in temperature. Myxedema coma can actually result in death. Fortunately, the condition is rare. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of myxedema coma?

The common symptoms of myxedema coma are:

People who have myxedema coma are in or near a coma and not able to function normally. They require emergency care.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

People who have hypothyroidism and develop fever, changes in behavior or mental status, shortness of breath, or increased swelling of the hands and feet should be taken to an emergency department.

Causes

What causes myxedema coma?

If you have hypothyroidism, then any of the following can contribute to myxedema coma:

  • Infections, especially lung and urine infections
  • Heart failure
  • Stroke
  • Trauma
  • Surgery
  • Drugs, such as phenothiazines, amiodarone, lithium, and tranquilizers, and prolonged iodide use
  • Not taking prescribed thyroid medications

Risk factors

What increases my risk for myxedema coma?

Please consult your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is myxedema coma diagnosed?

Blood tests are performed to check blood cell count, electrolytes, sugar, and thyroid hormone levels. Tests are also performed to evaluate how the liver and adrenal glands are functioning.

Blood gases are evaluated to check for oxygen and carbon dioxide levels.

An ECG of the heart is performed to check for disturbances in the activity of the heart.

Additional tests are performed at the discretion of the treating doctor.

How is myxedema coma treated?

Treatment may include assisting the patient to breathe and warming them to raise the body temperature to normal. Often, antibiotics are started until it is certain that an infection is not present.

The method of replacing thyroid hormone in patients with myxedema coma is controversial. Many different approaches are used. In general, initial replacement is done by intravenous infusion, since the intestinal system may not be absorbing properly.

While common hypothyroidism without myxedema is usually treated with T4 replacement (the hormone produced in greatest quantity by the thyroid gland), in the case of myxedema coma, management is different. The thyroid gland also produces a small amount of another hormone, T3. This is the more metabolically active of the two hormones. In patients who are well, T4 is converted into T3 in the bloodstream. However, patients with myxedema coma are often so sick that this conversion is impaired. As a result, many doctors choose to treat these patients with T3 initially and start T4 therapy as well. Since T4 therapy can take a month or so to work, there is usually an overlap of these two hormones. Care is taken to avoid heart rhythm abnormalities (arrhythmias) and stress on the heart, which can be caused by replacing thyroid hormone too quickly, particularly in elderly patients.

While mild thyroid disorders can be managed by primary care physicians, myxedema coma is generally managed by a thyroid specialist (endocrinologist) because treatment can be complicated and critical.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage myxedema coma?

The ideal way to manage this condition is to prevent it from occurring in the first place. An individual with hypothyroidism should visit their doctor regularly for follow-up and blood testing to be certain that their replacement dose is appropriate.

If an individual has symptoms that concerns them, but has not been diagnosed with hypothyroidism, they should visit their health care practitioner to discuss their concerns and explore the option of testing for thyroid imbalance.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: October 31, 2017 | Last Modified: October 31, 2017

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