Myxedema coma

Short description: Medical condition

Myxedema coma

Myxedema coma is an extreme or decompensated form of hypothyroidism and while uncommon, is potentially lethal.[1][2][3] A person may have laboratory 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. Primary symptoms of myxedema coma are altered mental status and low body temperature. Low blood sugar, low blood pressure, hyponatremia, hypercapnia, hypoxia, slowed heart rate, and hypoventilation may also occur.[4] Myxedema, although included in the name, is not necessarily seen in myxedema coma. Coma is also not necessarily seen in myxedema coma.[5]

According to newer theories, myxedema coma could result from allostatic overload in a situation where the effects of hypothyroidism are amplified by nonthyroidal illness syndrome.[6]

## Contents

* 1 Pathophysiology
* 2 Diagnosis
* 3 Epidemiology
* 4 See also
* 5 References
* 6 External links

## Pathophysiology

Precipitating factors of myxedema coma include:[1][2][3]

* Medications
* Amiodarone
* Anesthesia
* Barbiturates
* Beta-blockers
* Diuretics
* Lithium
* Narcotics
* Phenothiazines
* Phenytoin
* Rifampin
* Tranquilizers
* Sedatives
* Withdrawal of thyroid supplements
* Anti-TNF therapy
* Burns
* Carbon dioxide retention or hypercapnia
* Cold exposure
* Gastrointestinal bleeding
* Low blood sugar or hypoglycmia
* Low body temperature or hypothermia, especially during winter months
* Low oxygen levels or hypoxia
* Infection
* Cellulitis
* Pneumonia
* Influenza
* Urinary tract infection and urosepsis
* Sepsis
* Stroke or cerebrovascular accidents
* Surgery (given the effect on pituitary-thyroid axis with decrease thyroid hormones secretion after surgery in response to stress)
* Trauma
* Motor vehicle accidents
* Fractures
* Congestive heart failure
* Consumption of raw bok choy
* Diabetic ketoacidosis (DKA) after total thyroidectomy.

## Diagnosis

Clinical features of myxedema coma:[1][2][3]

* Cardiovascular
* Bradycardia
* Bundle branch blocks
* Complete heart block and arrhythmias
* Cardiomegaly
* Elevated diastolic blood pressure—early
* Hypotension—late
* Low cardiac output
* Non-specific ECG findings
* Pericardial effusion
* Polymorphic ventricular tachycardia (torsades de pointes)
* Prolonged QT interval
* Respiratory
* Hypoxia
* Hypercarbia
* Hyperventilation
* Myxedema of the larynx
* Pleural effusion
* Gastrointestinal
* Abdominal distention
* Abdominal pain
* Anasarca
* Anorexia and nausea
* Decreased motility
* Fecal impaction and constipation
* Gastric Atony
* Myxedema or toxic megacolon—late
* Neurogenic oropharyngeal dysphagia
* Paralytic ileus
* Neurological
* Altered mentation
* Coma
* Confusion and obtundation
* Delayed tendon reflexes
* Depression
* Poor cognitive function
* Psychosis
* Seizures
* Renal and urinary function
* Bladder dystonia and distension
* Fluid retention
* Appearance and dermatological
* Alopecia
* Coarse, sparse hair
* Dry, cool, doughy skin
* Myxedematous face
* Generalized swelling
* Goiter
* Macroglossia
* Non-pitting edema
* Ptosis
* Periorbital edema
* Surgical scar from prior thyroidectomy
* Hypothermia

Laboratory features in myxedema coma:[1][2][3]

* Anemia
* Elevated creatine kinase (CPK)
* Elevated creatinine
* Elevated transaminases
* Hypercapnia
* Hypercholesterolemia (elevated LDL)
* Hyperlipidemia
* Hypoglycemia
* Hyponatremia
* Hypoxia
* Leukopenia
* Respiratory acidosis

## Epidemiology

Hypothyroidism is four times more common in women than men. The incidence of myxedema coma has been reported to be 0.22 per 1000000 per year but the data is limited and especially lacking in countries outside the western world and countries along the equator. Myxedema coma is most common in people 60 years old and older and is most common in the winter months when hypothermia is more common.[1][2][3]

## See also

* Thyroid storm
* Euthyroid sick syndrome

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 Wall, Cristen Rhodes (2000-12-01). "Myxedema Coma: Diagnosis and Treatment". American Family Physician 62 (11): 2485–2490. ISSN 0002-838X. PMID 11130234. https://www.aafp.org/afp/2000/1201/p2485.html.
2. ↑ 2.0 2.1 2.2 2.3 2.4 Mathew, Vivek; Misgar, Raiz Ahmad; Ghosh, Sujoy; Mukhopadhyay, Pradip; Roychowdhury, Pradip; Pandit, Kaushik; Mukhopadhyay, Satinath; Chowdhury, Subhankar (2011-09-15). "Myxedema Coma: A New Look into an Old Crisis" (in en). Journal of Thyroid Research 2011: 493462. doi:10.4061/2011/493462. PMID 21941682.
3. ↑ 3.0 3.1 3.2 3.3 3.4 Elshimy, Ghada; Correa, Ricardo (2021). Myxedema. StatPearls Publishing. PMID 31424777. https://www.ncbi.nlm.nih.gov/books/NBK545193/.
4. ↑ Berghe, edited by Greet van den; Wartofsky, Leonard (2008). Acute endocrinology : from cause to consequence (1 ed.). New York: Humana Press. pp. 29–44. ISBN 978-1-60327-176-9. https://archive.org/details/acuteendocrinolo00berg.
5. ↑ Gardner, David G., Shoback, Dolores M., Greenspan, Francis S. (2017). Greenspan's basic & clinical endocrinology (10th ed.). McGraw-Hill Education. pp. 783. ISBN 978-1259589294. OCLC 1075522289.
6. ↑ Chatzitomaris, Apostolos; Hoermann, Rudolf; Midgley, John E.; Hering, Steffen; Urban, Aline; Dietrich, Barbara; Abood, Assjana; Klein, Harald H. et al. (20 July 2017). "Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming". Frontiers in Endocrinology 8: 163. doi:10.3389/fendo.2017.00163. PMID 28775711.

## External links

Classification|

* ICD-10: E03.5

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External resources|

* eMedicine: article/123577

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