Myxedema

Excerpt

Myxedema coma is a rare and extreme complication of hypothyroidism with multiple organ abnormalities associated with altered sensorium, it can be fatal. Hypothyroid patients exhibit multiple physiologic alterations to compensate for the deficiency of thyroid hormone. Factors like infection can overwhelm these homeostatic mechanisms and can lead to myxedema coma. Myxedema coma can be an initial presentation of any form of hypothyroidism, irrespective of the cause. Even with early diagnosis and treatment of myxedema coma, the mortality rate is variable, with some reports as high as 60% and others as low as 20 to 25% even with intensive care.

Myxedema is commonly used often in the context of hypothyroidism and myxedema coma, it also means edema of the skin and soft tissue in hypothyroidism. Myxedema coma is a misnomer. Neither the patients have classic nonpitting edema, nor are they in a coma. The most salient feature of myxedema coma is deteriorating mentation.

A high index of suspicion, early recognition, admission to intensive care units, and treatment with intravenous levothyroxine and hydrocortisone are paramount in the management of myxedema coma. History of any thyroid dysfunction, thyroid medication, adherence with thyroid medication, thyroid surgery, and history of any drugs that may affect thyroid function require assessment in any patient suspected myxedema coma.