The name myxedema comes from the Scottish physician William Miller Ord, who in 1877 found out the connection between the appearance of tissue swelling and hypothyroidism. Myxedema is a symptom of various thyroid disorders and occurs all over the body or locally. In its worst form, myxedema coma, it can even lead to death.
What is myxedema?
Myxedema is a symptom of various thyroid disorders and occurs all over the body or locally. The illustration shows the location of the thyroid gland in the body. Myxedema is a hormonally induced abnormal storage of glycosaminoglycans in the subcutaneous tissue. These substances are sugar-protein compounds that have a high water-binding capacity. In patients with myxedema, they are insufficiently broken down. If the entire body is affected, the condition is generalized myxedema (classic myxedema). If the tissue swelling is limited to the edges of the shin and the back of the foot, medicine refers to it as localized pretibial myxedema. In this swelling, too, no dents remain when pressure is applied to the affected skin area. Patients with myxedema have doughy swollen skin areas. In addition, their skin surface feels cool and is rough and dry. In generalized myxedema, the entire body appears bloated. If the underlying hypothyroidism is not treated in time, myxedema coma may occur under certain conditions (exposure to cold, stressors, overexertion). Myxedema causes impaired consciousness and even coma, and is fatal in 30 percent of cases if emergency medical services are not notified immediately.
Causes
Generalized myxedema is caused by hypothyroidism. Physicians believe that a disturbance in T3 hormone is responsible for the decreased breakdown of the muco-polysaccharides hyaluronic acid and chondroitin sulfate in connective tissue. In the localized form of myxedema, subcutaneous fibroblasts are stimulated by TRAKs causing hyperthyroidism. Both thyroid disorders are congenital or acquired and have a 1 in 5,000 chance of occurring. Hashimoto’s thyroiditis – a form of hypothyroidism – is an acquired autoimmune disease. Surgical removal of thyroid tissue can also cause hypothyroidism. If a person ingests too much iodine over a long period of time, hypothyroidism can occur. Failure or insufficient secretion of TSH due to pituitary gland disease can also cause myxedema. Hyperthyroidism can be caused, for example, by an overdose of thyrostatic drugs – which in turn causes a thyroid hormone deficiency. The administration of lithium to treat depression can also lead to hyperthyroidism. Myxedema coma can result from ingestion of painkillers and sedatives, cold, and also spontaneously. Classic myxedema is recognizable by swollen facial folds, swollen tongue, and puffy upper eyelids. As a result, the eyes take on a slit shape. The slowed metabolism causes symptoms such as freezing, fatigue and dullness, dry, dull hair, hair loss, dry skin, and hoarse voice. But constipation, muscle stiffness, weight gain despite reduced appetite, muscle cramps, hearing loss, forgetfulness, depression and, in women, very heavy menstruation are also signs. Sometimes anemia, elevated blood pressure and high cholesterol levels also occur. The problem is that many of the symptoms are also typical of other diseases and of general states of exhaustion. Therefore, it is common for hypothyroidism to go undetected, especially in older patients. They are therefore at particular risk of developing myxedema coma, which manifests itself in the form of breathing difficulties, slowed heartbeat (bradycardia), hypothermia, bowel paralysis and pericardial effusion (accumulation of fluid in the pericardium). Due to the inadequate supply of nutrients and oxygen, the patient falls into a coma. The following symptoms are characteristic of localized pretibial myxedema: swelling on the sides of the shins and on the tops of the feet, ravenous hunger, nervousness, sweating, diarrhea, and palpitations.
Diseases with this symptom
- Hashimoto’s thyroiditis
- Graves’ disease
- Autoimmune disease
- Pericardial effusion
- Hypothyroidism
- Anemia
Diagnosis and course
Myxedema are easily recognized externally. The underlying thyroid disorders can be diagnosed by blood tests. The TSH level, free thyroxine (fT4) – the level is usually too low – and possibly the T3 level are determined. In hypothyroidism, the TSH level is very high – unless TSH deficiency is the cause of the hypothyroidism.
When should you see a doctor?
Myxedema should always be treated by a doctor. If no treatment of this disease occurs, in the worst case it can also lead to the death of the patient. The symptoms of myxedema are very varied and in most cases do not give a direct indication of the disease. In most cases there is depression, fatigue and hair loss. However, those affected also suffer from hearing loss, cramps in the muscles or weight gain. Therefore, if these symptoms occur, a doctor must be contacted immediately. Breathing difficulties or cold extremities can also be symptoms of myxedema. It is not uncommon for patients to appear nervous and stressed and suffer from sweating and ravenous appetite. The patient’s ability to cope with stress also drops enormously, leading to a reduced quality of life. Even if the affected person is not sure about the symptoms, a doctor should be consulted in any case. This can diagnose whether it is actually a myxedema.
Treatment and therapy
The treatment of myxedema depends on which underlying disease is present. If hypothyroidism is the culprit, the physician will permanently prescribe L-thyroxine to replace the deficient T4. If there is only a slight hypothyroidism, the patient can also take homeopathic constitutional remedies such as Calcium Carbonicum, Graphites, Pulsatilla or Barium Iodatum. It also helps to change the body to a low-carbohydrate, low-acid diet and to season food with iodine-containing sea salt. For those who prefer Schuessler salts, magnesium Phos. No. 7, Kalium Bromatum No. 14 and Kalium Iodatum No. 15 are recommended. In hyperthyroidism, thyrostatic drugs are administered to curb hormone production and – as a sustained treatment – radioiodine therapy is performed. In Graves’ disease, most of the goiter is surgically removed. In myxedema coma, T3 is administered in the form of triiodothyronine or T4. The patient also receives an infusion of glucocorticoids, glucose, and salts. If his body is severely hypothermic, it is carefully warmed.
Outlook and prognosis
As a rule, myxedema is very easy to recognize externally, so that treatment can be carried out relatively quickly and, above all, early. In many cases, sufferers experience constipation or weight gain. Women often also suffer from heavy menstruation. Patients experience impairments of the sensory organs, so that, for example, seeing and hearing can only take place with difficulty. Psychological problems such as depression may also occur. Myxedema may also carry signs of a common cold, so that patients complain of cold extremities or headaches. These symptoms can interfere with the patient’s daily life, reducing quality of life. For many people, an ordinary daily routine is then no longer possible. In many cases, myxedema can be treated relatively easily and does not lead to further discomfort. The treatment is carried out by taking a medication. A healthy diet with few carbohydrates and acids is also suitable in this case. If myxedema occurs in young children or in newborns, it can also be treated with the help of medication. Again, the treatment does not lead to further complications.
Prevention
Prevention is not possible in hypothyroidism unless it is caused by iodine deficiency. Newborns have a blood sample taken at the end of the first week of life and a thyroid hormone study is performed. If there is a deficiency, they are treated with medication to prevent cretinism.
What you can do yourself
How can patients make living with their diagnosis as easy and as comfortable as possible? First, it is important to follow the doctor’s advice and prescriptions.But the often-heard tip “lots of exercise” should also play a role in everyday life, because it is fundamental for all people. Many find self-help groups a welcome support, because they receive valuable information and helpful insights in exchange with other sufferers. Conversation and contact also keep the soul in balance. Soul and body need attention right now. Among like-minded people, for example, recipes are exchanged and experiences with special foods that can increase well-being. A healthy diet with fruits and vegetables and a sufficient supply of proteins and calcium form the basis for an increase in well-being in any case. And some people report special treatment methods such as radioiodine therapy. A clarifying discussion about this can be held with the attending physician at the next visit to the doctor. As an expert, he will find out the right remedy. After all, each patient has her own individual medical history and requires a treatment method tailored to her.
