Myxedema: what it is, characteristics and associated symptoms

Myxedema is a complicated medical condition that is the result of hypothyroidism not being properly diagnosed and treated.

This medical problem can be quite problematic for the life of the person who suffers from it, since it involves serious dermatological changes, fluid retention and some cognitive problems.

It can worsen, giving rise to myxedema crises., in which its consequences can be fatal, leading to coma and death. Below we will discover more symptoms of this disease, what are its possible causes and how it is treated.

Related article: "Types of hormones and their functions in the human body"

What is myxedema?

Myxedema is another term to refer to severely advanced hypothyroidism.. Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormone. The thyroid is a gland that releases hormones that are responsible for regulating energy levels and the general functioning of the body. In case there is a bad production of these hormones, several of the functions of the organism are affected.

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Very advanced hypothyroidism can cause a myxedema attack, which is a very serious medical condition that requires urgent intervention.

The word myxedema is used, above all, to refer to the dermatological symptoms of advanced hypothyroidism and the clinical picture associated with it. Among the main skin changes that can occur as a result of a malfunction of the thyroid gland we have: Swelling on the face, including lips, eyelids and tongue.

Swelling and thickening of the skin anywhere on the body, especially the lower legs.

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Symptoms

In addition to the changes in the skin that we have already mentioned, other symptoms can be associated in the myxedema box.

low blood pressure
Low heart rate (low heart rate)
Sparse and brittle hair
Goiter (enlargement of the thyroid gland)
Low energy and lethargy
Weight gain
Weakness
cold intolerance
Constipation
depressive symptoms
skin thickening
rough skin
Negative Godet's sign.
Change in facial appearance
Thick nose.
Gelatinous infiltrations in the subcutaneous tissue
speak slow
mental slowness
Lethargy
Mental problems
Pale yellow dry skin
Swollen subcutaneous tissues
Weight gain
Constipation
Brittle and sparse hair
bald
Muscle pains
Hearing loss and deafness
Carpal tunnel syndrome

myxedema attack

Myxedema crisis, also called myxedema coma, is an urgent medical condition that occurs when the body cannot tolerate the changes associated with severe hypothyroidism. The body is decompensated, with very abnormal levels of different substances that make it difficult for the body to function properly.

respiratory depression
Low levels of sodium in the blood
Hypothermia: body temperature less than 35º
Confusion and worrisome mental slowness
shock
Low blood oxygen levels
High levels of carbon dioxide in the blood
Eat
seizures

The myxedema crisis can cause death due to complications from infection, hemorrhage, or respiratory failure. It is more common in women (80%) and people over 60 years of age, appearing especially in winter. It can happen during pregnancy too.

Causes

As we have seen, hypothyroidism occurs when the thyroid gland does not work properly. There are several reasons that can explain why the thyroid gland fails or is working less than it should, among which we can highlight:

Autoimmune disease, including Hashimoto's disease
Surgical removal of the thyroid gland
Radiotherapy
Certain drugs, such as lithium and amiodarone (Pacerona)
Iodine deficiency or excess
Pregnancy
Medications for the immune system, such as those used for cancer

Usually, the dermatological problems of myxedema and the crisis associated with this medical problem occur when severe hypothyroidism has not been adequately diagnosed and treated. It can also occur as a consequence of abandoning thyroid medication, causing this clinical picture to occur.

One of the biological explanations that have been given to explain myxedema has to do with the deposits of carbohydrate chains, specifically mucopolysaccharides. These substances accumulate in the skin, damaging it. In addition, they explain the swelling since they are substances that attract water, causing it to accumulate in the skin.

As for the myxedema crisis, which as we have commented is much more serious, This usually occurs more in the winter months and can be triggered by the following factors:

Stop following a treatment for hypothyroidism
Having a heart attack or stroke
Infection
trauma
Use of central nervous system suppressive drugs
cold exposure
Stress

How is myxedema diagnosed?

Myxedema is a medical condition that, when it occurs, does not go unnoticed. Whether in the form of a crisis or in its less urgent form, the doctor will quickly diagnose that you are suffering from myxedema, and proceed to intervene. To confirm the diagnosis, a blood test can be performed that looks at the levels of sodium, carbohydrates, oxygen and carbon dioxide..

In myxedema it often happens that the pituitary gland increases the production of thyroid stimulating hormone when the thyroid gland is not working enough. The thyroid gland test is accompanied by the thyroxine (T4) test, a hormone that is produced directly in the thyroid. If there is high production of thyroid-stimulating hormone but low thyroxine, it is a biological indicator of hypothyroidism.

Regarding the myxedema crisis, given the seriousness of the situation, proceed quickly and confirm the diagnosis as soon as possible. For this reason, medical personnel will focus on the following symptoms to confirm or reject the diagnosis and intervene urgently:

Dry Skin
sparse hair
Hypothermia
Swelling in the face and legs
goiter
Possible scar from a thyroidectomy
Low blood pressure and heart rate
Confusion
breathing slowing

Complications of myxedema

The thyroid gland is very important for the proper functioning of the body.especially metabolism. In very advanced hypothyroidism it usually happens that the metabolism is very slow, affecting the use of oxygen. This very negatively affects all organic processes and body systems, which can lead to the following medical complications if the myxedema is not treated.

Hypothermia
Swelling and fluid retention
Low drug metabolism and risk of accumulation
Problems in pregnancy, such as miscarriage, preeclampsia (chronic high blood pressure), premature birth, and birth defects
Heart failure
Renal problems
Depression
Eat
Death

How is myxedema treated?

To avoid myxedema, hypothyroidism should be treated beforehand, since it is that medical problem that causes it. For this, the treatment focuses on administering a synthetic version of the T4 hormone called levothyroxine (Levothroid, Levoxyl).

Once administered, T4 levels are restored, making the symptoms easier to control. Although it may take weeks for acceptable improvement, it can be said that this intervention is very effective. Likewise, the patient will most likely have to take the drug for the rest of his life.

As for myxedema crises, treatment is urgent. The patient will receive intensive care and the first therapeutic option consists of give thyroid hormone as replacement therapy, given intravenously. Some blood tests will also be carried out to confirm the levels of different substances.

Prevention is preferable to treatment because, in the event of a crisis, even receiving emergency treatment, mortality is quite high, between 25 and 60%.

Bibliographic references:

Berger, William D. James, Dirk M. Elston, Timothy G. (2011). Andrews' Diseases of the skin: clinical dermatology (11th ed.). [London]: Saunders/Elsevier. ISBN 978-1-4377-0314-6.
McConahey, W. m. (March 1978). Diagnosing and treating myxedema and myxedema coma. Geriatrics. 33 (3): 61–66. ISSN 0016-867X. PMID 624451
Lindholm, J.; Lauberg, P. (2011). Hypothyroidism and Thyroid Substitution: Historical Aspects. Journal of Thyroid Research. 2011: 809341. doi: 10.4061/2011/809341. PMC 3134382. PMID 21760981.