Myxedema

Myxedema – General Information

Myxedema is a skin and tissue disease that is usually due to several prolonged hypothyroidisms (which is a disease caused by the insufficient production of the thyroid hormone by the thyroid gland). Hypothyroidism is caused by Hashimoto’s thyroiditis (which is an autoimmune disease in which the antibodies attack the cells of the thyroid), surgical removal of the thyroid and other rare conditions. In adults that have Graves’ disease (which is a thyroid disorder, characterized by Hypothyroidism, exophathalmos and goitre-is a swelling in the neck due to an enlargement of the thyroid-) often appear partial forms of Myxedema in the lower parts of the legs, called  pretibial Myxedema (which is an infiltrative dermopathy). Myxedema can appear in Hypothyroidism, as a result to the accumulation of increased quantities of hyaluronic acid (which is a non-sulfate glycominoglycan) and chondroitin sulfate (which is also a non-sulfate glycominoglycan) in the dermis (which is the layer of the skin, situated beneath the epidermis). This appears in the healthy skin as well as in the lesional skin. What causes Myxedema is not yet defined, but the studies that have been made on the animals, reveal that the thyroid hormones affect the synthesis and the catabolism of  mucopolysaccharides and collagen (that is the main protein in the connective tissues in animals and also in mammals) by dermal fibroblasts (a fibroblast is a cell that synthesizes and also maintains the extracellular matrix). These fibroblasts localized in the orbital and pretibial dermis share antigenic sites, which are molecules that stimulate an autoimmune response, underlining the autoimmune process that produces Grave’s disease.

Myxedema – Symptoms

It is well known that any medical disorder (including Myxedema) can trigger a variety of symptoms. Therefore, some of this medical condition's most uncommon symptoms have not been mentioned 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 Myxedema or from any other medical disorder.
Here is a list of the most common symptoms of this disease:

• A thickening of the skin
• Coarse skin
• A change in the facial appearance
• Thickening nose
• Swollen lips (including lip pain, tingling lips, numb lips) and also swollen subcutaneous tissues
• A puffiness around the eyes
• A jelly-like infiltration in the subcutaneous tissues
• Slow speech – meaning a difficulty in speaking, problems of the voice and speech.
• Mental dullness (meaning that the mental abilities are reduced) and also mental problems (that affect thought, judgement and intelligence).
• Lethargy
• Dry and yellow skin
• Some patients may manifest a weight gain
• Constipation (is a medical condition where a person experiences feces that are difficult to egest)
• Thinning and brittle hair
• Bald patches
• Muscular pains
• Deafness
• Hearing difficulties
• Carpal tunnel syndrome (is a medical condition in which the median nerve is compressed at the wrist, and this can lead to pain, paresthesias, or muscle weakness in the forearm and hand).

Myxedema – Treatment

Here is a list of the Myxedema’s treatments:

• Treatment for the underlying cause (that include: Hypothyroidism, goitre, Hashimoto’s thyroiditis, thyroid surgery, Grave’s disease- that rarely produces a Myxedema of the legs and shin called pretibial Myxedema).
• Treatment of Hypothyroidism
• Thyroid hormone replacement
• Thyroxine

 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 Thyroxine). Both treatments control the disease, but it seems that the synthetic forms are more efficient because their effects are more regulated. Even if the treatment provides the necessary quantity of hormones, Hypothyroidism usually continues throughout life and the majority of the patients can require a lifelong follow-up treatment and medication in order to control this medical condition. 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 Thyroxine, 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. “TSH” means thyroid stimulating hormone, and is produced in the pituitary gland. This blood test reveals where the thyroid level should be in a patient, for example if the TSH is high this means that the thyroid level is too low and that the patient’s dose must be increased, and a low TSH means that the thyroid level is high and the dose must be decreased. However, if the dose is too high can cause symptoms associated with Thyroxine (this includes: palpitations, shakiness, irritability, weight loss, diarrhea, fatigue), and if the dose is too low can cause symptoms associated with c (such as: sluggishness, muscle cramps, weight gain, constipation and fatigue), but there are case in which even if the dose is too high or too low the symptoms do not appear, and this is why patients should make periodic blood test. The treatment for pretibial Myxedema consists of topical steroids (such as corticosteroids which are produced in the adrenal cortex. Corticosteroids are involved in physiologic systems, like: stress response, immune response and regulation of the inflammations, protein and carbohydrate catabolism, behavior and blood electrolyte levels. Glucocorticoids regulate many aspects of the metabolism and immune functions.). Patients usually have to apply a thick layer of steroid cream on the affected area and then they have to cover it with cellophane, in order to facilitate the absorption.