Today, I'm going to share with you about myxedema. In these contents, I divide into 10 parts.
1. Definition of Myxedema
2.Epidemiology of Myxedema
3.Etiology of Myxedema
4.The factor of Myxedema coma
5.Pathophysiology of Myxedema
6.Signs and symptoms of Myxedema
7.Differential diagnosis of Myxedema
8.Diagnosis of Myxedema
9.Complication of Myxedema
10.Treatment
11.Prognosis of Myxedema
Before I'm going to talk about Myxedema. I will late you know Why I decide to write this topic? because I already research on many websites. They said this disease is so rare all over the world but I hope can see it at one time. If you see kind of this disease: don't forget to comment on my blog and late me know.
If you read this as a medical student or a doctor don't forgive me If I'm wrong. Feel Free leave me a comment and Email also
1.Definition: Myxedema is skin and tissue disorder usually due to severe prolonged hypothyroidism.
Note: I make sure to understand two meaning difference between myxedema and myxedema coma(Crisis)
Myxedema refers to a swelling of the skin and soft tissue that occurs in the hypothyroid patients.
Myxedema coma occurs when the body's compensatory responses to hypothyroidism are overwhelmed by precipitating factors such as infection.
2.Epidemiology:
(rare) One study reports 200 cases in American: between 1953 and 1996.
The prevalence of myxedema is still unknown.
The Mortality rates: 30% to 60%
All hypothyroidism patients are female more than males to have myxedema four times and 80% of myxedema coma occur in females.
Myxedema is likely to have on both sexes, women, and men.
Ages: 60years and older.
3.Etiology
Myxedema from both hyperthyroid and hypothyroid conditions.
Hypothyroidism can be caused by Hashimoto's thyroiditis, surgical removal of the thyroid(thyroidectomy), and rarer conditions.
Hyperthyroidism is associated with pretibial myxedema and exophthalmos. in pretibial myxedema have 1-4% of patient with graves' disease.
4.Factors Known to precipitate Myxedema coma:
Burns(severe Hypothermia): late to brief period of bradycardias and more than 4 hours can lead to respiratory failure.
Gastrointestinal tract hemorrhage: cause by coagulopathy and microcytic anemia( Vit.B12 deficiency)
Infection: Pneumonia, Influenza, UTI/Urosepsis, Sepsis
Medication: Amiodarone(Cordarone), Anesthesia(in emergency cases), Beta-blockers, Diuretics
Stroke, Surgery, Trauma
5.Pathophysiology:
Results from the accumulation or increased amounts of hyaluronic acid and chondroitin sulfate in the dermis in both lesions and normal skin.
Describe a specific form of cutaneous and dermal edema secondary to increase the connective tissue component.
Connective fiber are separated by an increase amount of protein and mucopolysaccharides include glycosaminoglycans(Hyaluronic acid and chondroitin sulfate)
Protein-Mucopolysaccharides complex binds water to produce Non-pitting edema around eyes, hands, feet, and heart) leading to myxedema.
6.Signs and symptoms:
History: Taking the history of hypothyroidism, may have developed hypothyroidism after thyroidectomy or iodine therapy for hyperthyroidism.
Symptoms: fatigue, weight gain, cold intolerance, constipation, and dry skin, maybe elicited.
Patients have a depressed mental state with lethargy, delirium, or coma.
symptoms of precipitating illness can be seen such as infection(commonly pneumonia) stroke, myocardial infarction, trauma, or heart failure.
Physical Examination: Physical findings may include the following:
Hypothermia, Hypotension, Bradycardia, Decrease pulse pressure, normal systolic pressure and elevated diastolic pressure, Decreases respiratory rate, Periorbital puffiness, Macroglossia, coarse or thinning hair, small thyroid, slow respiratory rate, signs of pleural effusion, soft or distant heart sounds, diminished apical impulse and pericardial effusion.
Abdominal distension(ascites), Diminished or absent bowel sounds(ileus), Bladder distension, Cold extremities, non-pitting edema if upper and lower extremities, cool, pale, dry, scaly and thick skin, dry, brittle nails, ecchymoses, purpura, confusion, stupor, slow speech, delayed reflexes, seizures and coma.
7.Diagnosis
Taking history and PE
Laboratory studies: Thyroid function test: TSH, Free Thyroxine(T4), Free Triiodothyronine(T3)
Adrenal Function Test: Serum Cortisol: very low below 3mcg/dl or high above 20 mcg/dl (normal 10-20mcg/dl)
Hyponatremia with low serum osmolality
Hypoglycemia
CBC
Imaging studies: Chest X-ray: signs of cardiomegaly, pericardial effusion, congestive heart failure or pleural effusion.
other tests: ECG: Bradycardia
8.Differential Diagnosis
Hypothermia, Hypoventilation syndrome, Septic shock
9. Treatment: is to see a doctor to treatment depending on location and protocol. but if you have hypoxygenation to ventilation as soon as possible and need serum for hyponatremia.
In my advice to need to see the doctor as soon as possible don't keep your health get worse.
10.Complication:
Respiratory failure, Myocardia ischemia, Renal Failure, Sepsis, GI hemorrhage, Coma.
11.Prognosis
The mortality rate:70-80%(in the past)
The mortality rate: 20%( last 10-15 years)
Recognized earlier
Receiving intensive supportive care
Treated with thyroxine early in the course of illness
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