Myxedema: Symptoms, Treatment

Question. Write a short note on myxedema. 

Answer. Myxedema is a clinical condition resulting from decreased circulating levels of T3 and T4.

It is characterized by the deposition of mucinous material causing swelling of the skin and subcutaneous tissue.

Clinical Features Of Myxedema 

• General: There is tiredness, somnolence, weight gain, cold intolerance, and goiter.
• Skin and subcutaneous tissue: Coarse dry skin, puffiness of face with malar flush, baggy eyelids with swollen edematous appearance of supraclavicular regions, neck, and lack of hand and feet.
• Cardiovascular and respiratory features: Bradycardia, angina, cardiac failure, pericardial effusion, and pleural effusion.
• Neuromuscular features: Aches and pains, cerebellar syndrome with slurred speech and ataxia, muscle cramps, and stiffness.
• Gastrointestinal features: Constipation and ascites
• Developmental: Growth and mental retardation
• Reproductive system: Infertility, menorrhagia, hyperprolactemia, and galactorrhea.

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Myxedema: Symptoms, Treatment

Investigation Of Myxedema 

• Serum T3 and T4 are decreased.
• Serum TSH level is high
• Creatinine level increases
• Serum cholesterol level is increased
• BMR is low
• Iodine uptake by the thyroid is poor
• ECG can show bradycardia, low amplitude of QRS and
  ST­T changes.
• The blood picture shows macrocytic anemia.
• X­ray chest can be normal or show cardiomegaly.
• Photomotogram reveals delayed ankle jerk.

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Management Of Myxedema 

• In patients with myxedema, adequate ventilation is maintained along with electrolyte balance and slow warming.
• The principle of therapy is the replacement of deficient thyroid hormones.
• Treatment of myxedema is the life­long replacement of thyroid hormones by L­thyroxine.
• The initial starting dosage is 50–100 µg daily as a single dose on an empty stomach in the morning for the first 3 to 4 weeks.
• After some time, the dosage can be increased to 150 µg/day.
• Adjustment of the final dosage should be done after assessing
• TSH levels.
• The maximum dosage of L–thyroxine is 300 µg/day.
• In geriatric patients or patients suffering from ischemic heart disease, a low dose of L–thyroxine 25 µg/day can be started and is increased after assessing the levels of TSH.
• Since the plasma half-life of L–thyroxine is 7 days so increase and decrease in dose should be done at an interval of 2 weeks.

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