Myxedema: Symptoms, Treatment & Coma

Myxedema: Symptoms, Treatment & Coma

Discuss briefly myxedema.

Answer. Myxedema is a clinical condition resulting from decreased circulating levels of T3 and T4. It is characterized by deposition of mucinous material causing swelling of skin and subcutaneous tissue.

“Comprehensive Overview Of Myxedema Symptoms”

Myxedema Clinical Features

• General: There is tiredness, somnolence, weight gain, cold intolerance and goiter.
• Skin and subcutaneous tissue: Coarse dry skin, puffiness of face with malar flsh, baggy eyelids with swollen edematous appearance of supraclavicular regions, neck and lacks 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 camps and stiffess.
• Gastrointestinal features: Constipation and ascites
• Developmental: Growth and mental retardation
• Reproductive system: Infertility, menorrhagia, hyperprolactinemia and galactorrhea.

“Symptoms Of Myxedema In Adults”

Myxedema Investigation

• Thyroid function test: There is reduction in T3 and T4 levels and rise in serum thyroid stimulating hormone which indicates primary hypothyroidism.
  Reduction in T3 and T4 levels with TSH level below normal range is secondary hypothyroidism.
• Serum cholesterol: It is raised in primary thyroid failure.
• The fall in serum level is more than 50 mg/100 mL.
• Tendon reflx duration is prolonged.
• In ECG bradycardia, low voltage complexes and flttned or inverted T waves are present.

“Treatment For Myxedema”

Myxedema Management

• In patient of myxedema adequate ventilation is maintained along with electrolyte balance and slow warming.
• Principle of therapy is replacement of deficient thyroid hormones.
• Replacement with L thyroxine 100 to 150µg/day. In old patients with ischemic heart disease initial therapy is with 25 to 50 µg/day and then gradually increased till the required dose.
• Drug may take at least a week to act.
• It is bettr to give the drug in morning hours to obviate sleeplessness.
• Initial rapid response is achieved by giving L iodothyronine 20µg TID.