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]

Myxedema coma
SpecialtyEndocrinology 

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]

Pathophysiology

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

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

References
  1. Wall, Cristen Rhodes (2000-12-01). "Myxedema Coma: Diagnosis and Treatment". American Family Physician. 62 (11): 2485–2490. ISSN 0002-838X. PMID 11130234.
  2. 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". Journal of Thyroid Research. 2011: 493462. doi:10.4061/2011/493462. PMC 3175396. PMID 21941682.
  3. Elshimy, Ghada; Correa, Ricardo (2021). "Myxedema". StatPearls. StatPearls Publishing. PMID 31424777.
  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. {{cite book}}: |first1= has generic name (help)
  5. Gardner, David G., Shoback, Dolores M., Greenspan, Francis S. (2017). Greenspan's basic & clinical endocrinology (10th ed.). McGraw-Hill Education. p. 783. ISBN 978-1259589294. OCLC 1075522289.{{cite book}}: CS1 maint: multiple names: authors list (link)
  6. Chatzitomaris, Apostolos; Hoermann, Rudolf; Midgley, John E.; Hering, Steffen; Urban, Aline; Dietrich, Barbara; Abood, Assjana; Klein, Harald H.; Dietrich, Johannes W. (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. PMC 5517413. PMID 28775711.
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