Myxedema coma history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

The function of all organ systems and various metabolic pathways are compromised in hypothyroidism. The cardinal symptoms of myxedema coma are the sensory impairment and hypothermia. The accumulation in the interstitial tissue of mucopolysaccharides and water leads to myxedema that compromises a large part of the tissues. Myxedema coma patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained.

Obtaining a history gives important information in making a diagnosis of myxedema coma. It provides an insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and helps in determining the prognosis. Myxedema coma patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be on the onset, duration, and progression of symptoms such as:

• History of thyroid disease
• History of radioiodine therapy or thyroidectomy
• Thyroid hormone therapy that was inappropriately discontinued

The function of all organ systems and various metabolic pathways are compromised in hypothyroidism. The cardinal symptoms of myxedema coma are the sensory impairment and hypothermia. The accumulation in the interstitial tissue of mucopolysaccharides and water leads to myxedema that compromises a large part of the tissues. Symptoms of myxedema coma can be summarized in the following table:^[1][2][2]

• Myxedema is a defined as deposition of mucopolysaccharides in the dermis at the periorbital level and is responsible for the typical bloated facies.
• It is accompanied by a thin, dry and brittle hair and even alopecia, loss of the tail of the eyebrows (sign of Queen Anne or supraciliar madarosis) and macroglossia, with cold skin (by reflex cutaneous vasoconstriction), pale-yellowish (from anemia and hypercarotinemia), dry and rough (elephant skin).

• It is defined by the presence of core body temperature (rectal) <35 ° C, although in general it is serious, with records between 26 ° C and 32 ° C.
• It is noted in most cases of myxedema coma, and due to a decrease in thermogenesis accompanying the decline of metabolism.
• Hypoglycemia also complicates hypothermia.
• There is a correlation between the degree of hypothermia and survival, with a worse prognosis for those with temperatures below 32 °.
• Occasionally, hypothermia may be absent in presence of serious infections. Thus, the diagnosis must be seriously considered in every afebrile patient with a serious underlying infection.