Q 1 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.
Read And Learn More: General Medicine Question And Answers
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.
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.
Q 2 Describe clinical manifestations and management of myxedema.
Or
Write a short note on the treatment of myxedema.
Answer.
Clinical Manifestations Of Myxedema
- Cold intolerance
- Thickness and dryness of skin and hair
- Swelling of hands and face
- Change in shape of face
- Thickening of lips is present
- Non-pitting edema is present
- There is a yellowish discoloration of the skin.
- Hoarseness of voice is present.
- There is a decrease or loss of sweating
- Loss of hair on the outer third of the eyebrows.
- Slow pulse/bradycardia.
Myxedema Treatment
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 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.
Q 3. Describe the clinical and diagnostic features of myxedema.
Answer.
Clinical Features Of Myxedema
- General: There is tiredness, *somnolence, weight gain, cold intolerance, and goiter.
- Skin and subcutaneous tissue: Coarse dry skin, puffiness of the 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.
Diagnosis is based on the Clinical signs of the patient and the investigations
Clinical Signs Of Myxedema
- Cold intolerance
- Thickness and dryness of skin and hair,
- Swelling of hands and face
- Change in shape of face
- Thickening of lips is present
- Non-pitting edema is present
- There is a yellowish discoloration of the skin.
- Hoarseness of voice is present.
- There is a decrease or loss of sweating
- Loss of hair on the outer third of the eyebrows.
- Slow pulse/bradycardia.
Investigations Of Myxedema
- Thyroid function test: There is a reduction in T3 and T4 levels and a rise in serum thyroidstimulating hormone which indicates primary hypothyroidism.
- Reduction in T3 and T4 levels with TSH levels 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 reflex duration is prolonged.
- In ECG bradycardia, low voltage complexes and flattened or inverted Twaves are present.
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