Myxedema Coma

Myxedema Coma – General Information

The thyroid gland is situated at the front part of the neck and is responsible for the thyroid hormone production, which are very important for all the body’s cells in order for them to work properly. In some conditions the thyroid becomes underactive and produces fewer quantities of hormones, this medical condition is called hypothyroidism. The people who have hypothyroidism have problems that reflect the underactivity of the body’s organs. The hypothyroidism has the following symptoms: weight gain, feeling cold, dry skin, fatigue and sleepiness. In the case when the thyroid hormones levels are very low and the symptoms worsen, the disease can result in a serious medical condition named Myxedema Coma, which is a rare and life threatening condition.

Here is a list of the causes that lead to Myxedema Coma, in the case that the patient has hypothyroidism:

• Lung and urine infections
• Trauma
• Surgery
• Not taking the medical thyroid medications
• Heart failure – meaning that the heart’s pumping power is lower than normal
• Stroke – meaning the sudden death of the brain’s cells that is due to any problem of blood supply
• Drugs, such as phenothiazines, amiodarone (which is used to control the abnormal rhythm of the heart), tranquilizers, lithium (which is used in the treatment of depressive and manic/depressive conditions and the prolonged use of iodide.

The Myxedema Coma can be prevented with the early treatment of the hypothyroidism, the regularly taking of the thyroid medications and with the recognition of the symptoms of this medical condition.

Myxedema Coma – Symptoms

Hypothyroidism is a medical condition in which the body does not have sufficient quantities of thyroid hormones. The scope of the thyroid hormones is to take care of the body’s metabolism this is why people who have this medical condition may present also the symptoms of a slow metabolism. It is well known that any medical disorder (including Myxedema Coma, hypothyroidism) can trigger a variety of symptoms. Therefore, some of this medical condition's most uncommon symptoms have not been listed here. This is why we strongly recommend you to contact your personal health care provider whenever you develop any unusual, bothersome or unpleasant symptoms. Your personal physician will be able to tell you if you are suffering from hypothyroidism that can lead to Myxedema Coma, or from any other medical disorder
The symptoms of hypothyroidism may include:

• Weakness
• Confusion
• Low body temperature
• Feeling cold
• Cold intolerance
• Difficulty in breathing
• Swelling of the body
• Fatigue
• Weakness
• A weight gain or a difficulty in losing weight
• Coarse, dry hair and also hair loss
• Muscle cramps and muscle aches
• Constipation
• Depression and also irritability
• Memory loss
• Women may present abnormal menstrual cycles
• Decreased libido
• Brittle fingernails – are nail’s abnormalities with color, shape, texture, and thicken of both fingernails and toe nails.
• Dry and flaky skin and also a thickening of the skin may be observed
• Puffy face, hands and also feet
• Decreased hearing
• Slow speech
• Hoarseness

Myxedema Coma – Treatment

People who have Myxedema are in a coma or nearly in one and they are not able to function normally. The friends and family should take them to the emergency department immediately and should not give them any thyroid medication before taking them to the emergency department as if the adrenal insufficiency is present the administration of the thyroid medications provokes an adrenal crisis. The patients who have Myxedema Coma should be in the intensive care unit and should have their hypovolemia and electrolyte abnormalities correctly treated. Mechanical ventilation can be necessary in some cases and the cardiovascular status should be carefully monitored, especially after the intravenous thyroid hormones replacement.

The thyroid hormone replacement is a treatment that is applied to any patient that is suspected of Myxedema Coma. There are some controversies related with the use and dosage of the levothyroxine (T4) and liothyronine (T3), although the necessity of intravenous thyroid hormones and replacement is obvious. The controlled studies comparing T3 and T4 are missing as there is a low number of persons who suffer from Myxedema Coma. There is the possibility of the development of secondary hypothyroidism associated with hypopituitarism and this is why hydrocortisone should be administrated before adrenal insufficiency has been ruled out. Hydrocortisone should be administrated intravenously at every eight hours and the failure of this kind of treatment may lead to the precipitation of an adrenal crisis.

Here is a list of drugs that are recommended in the patients who suffer from Myxedema Coma:

• Cytomel
• Eltroxin
• Euthyrox
• Levo – T
• Levothyroxine
• Levoxyl
• Liothyronine
• Synthroid
• Triostat
• Unithroid

As we said before the underlying cause of the Myxedema Coma is hypothyroidism. For the hypothyroidism there is no cure, this means that the patients who suffer from this medical condition will probably have to take daily thyroid hormones replacement therapy for the rest of their lives. The treatment of hypothyroidism is based on the underlying cause that produces it, meaning on the shortage of thyroid hormones, which is usually treated by supplementing the hormones.  The supplements can be natural hormones, which are extracted from the thyroid glands of the animals, or can be synthetic hormones (like levothyroxine). Both treatments control the disease, but it seems that the synthetic forms are more efficient because their effects are more regulated. Although many people benefit from this kind of treatment, not everyone needs it such as elderly people that suffer from other medical conditions and this treatment may worsen their health and the postmenopausal women who are taking high doses of hormones and that can be at a risk for accelerated bone loss. In the case of the thyroid hormone replacement treatment, patients usually take levothyroxine, which is a substance identical to the one that the thyroid gland produces and this is a treatment that need to be taken all life long. The dose of the hormones is established by the way the patients feel the physical examination and on the results of the blood test named TSH.