What Is Hypothyroidism Edema?

Hypothyroidism edema is just one of the many health complications caused by an under active thyroid gland.   An edema is the swelling that results from having excess fluids trapped under the skin.  Edemas can be pitting or non-pitting.  A pitting edema will develop a pit or dent when pressure is applied to the swelling.  A non-pitting edema doesn’t.  Hypothyroidism edema is the non-pitting type and is also referred to as generalized myxedema, not to be confused with Myxedema coma.  It is however a precursor condition to the coma and requires immediate medical treatment to prevent the (often fatal) coma stage from happening.

Myxedema causes pronounced swelling in the legs, arms and face.   The skin is generally pale, dry and cold to the touch.  There may also be some type of non-scarring, diffuse hair loss happening.  In very rare cases the patient may also develop cutis verticis gyrata, which is deep folds of skin on the scalp.

The swellings are the non-pitting type because of the accumulation of glycosaminoglycans (GAGs) under the skin.  GAGs are a type of molecule that plays an important role in maintaining and supporting collagen and elastin in the skin.  It’s also responsible for maintaining the bounce, or turgidity, in intracellular spaces.  When fluid abnormally accumulates beneath the skin in someone with a hypothyroidism edema or myxedema, these GAGs also abnormally accumulate in that fluid.  This is what gives these swellings their characteristic firm, ‘bouncy’ structure.

Other symptoms that go hand in glove with hypothyroidism edema include intolerance for cold, dry skin, hoarse voice, weakness, and physical and mental slowness.

Interesting Questions about Thyroid:

What Are the Main Types of Thyroiditis?

Chronic thyroiditis

Called Hashimoto’s thyroiditis, it is by far the most common form. It begins so slowly that most people don’t know anything is wrong. Over time, the disease destroys thyroid tissue until permanent hypothyroidism results. Some patients with Hashimoto’s have normal thyroid functions (euthyroidism) with a goiter.

Subacute thyroiditis

It’s a less common form, with far fewer cases than in chronic thyroiditis. Often caused by a viral infection, the disease lasts for several months. Subacute thyroiditis is painful, causing a tender, swollen thyroid gland with pain throughout the neck. The pain usually responds to treatment with aspirin or other anti-inflammatory drugs. At first, gland destruction causes the release of stored thyroid hormones, inducing temporary hyperthyroidism. A month or two later, the patient may become hypothyroid, because the thyroid has been damaged and its hormone reserves used up. Most patients return to normal within six to nine months, but the hypothyroidism could be permanent.

Painless thyroiditis

It causes a painless swelling of the thyroid gland. When this disease occurs after pregnancy, it is called postpartum thyroiditis. The course of painless thyroiditis is otherwise similiar to painful subacute thyroiditis.

Acute thyroiditis

A rare disease, is caused by an acute infection. Patients with the disease become very sick and have a high fever. The neck is red, hot, and very tender. Acute thyroiditis is a medical emergency and must be treated with antibiotics and surgery.

What About Nodules?

What are hot and cold nodules?

Thyroid nodules do not function like normal thyroid tissue. A thyroid image (scan) done with a radioactive chemical shows the size, shape, and function of the gland and of thyroid nodules. A nodule that takes up more of the radioactive material than the rest of the gland is called a hot nodule.

A nodule that takes up less radioactive material is a cold nodule. Hot nodules are seldom cancerous, but less than 10% of all nodules are hot. Cold nodules may or may not be cancerous. All lumps should be checked by your doctor.

How do doctors test nodules for cancer?

Your doctor can use several tests to find out whether or not a thyroid lump is cancerous.

  • A thyroid image or scan shows the size, shape, and function of the gland. It uses a tiny amount of a radioactive chemical, usually iodine or technetium, which the thyroid absorbs from the blood. A special camera then creates a picture, showing how much iodine was absorbed by each part of the gland.
  • In needle aspiration biopsy, a small needle is inserted into the nodule in an effort to suck out (aspirate) cells. If the nodule is a fluid-filled cyst, the aspiration often removes some or all of the fluid. If the nodule is solid, several small samples are removed for examination under the microscope. In over 90% of all cases, this testing tells the doctor whether the lump is benign or malignant.
  • Ultrasound uses high-pitch sound waves to find out whether a nodule is solid or filled with fluid. About 10% of lumps are fluid-filled cysts, and they are usually not cancerous. Ultrasound may also detect other nodules that are not easily felt by the doctor. The presence of multiple nodules reduces the likelihood of cancer.

How are nodules treated?

Nodules that are thought to be benign are usually observed at regular intervals. Some patients may be advised to take thyroid hormone pills. In certain instances, the nodule may be surgically removed because of continuing growth, pressure symptoms in the neck, or for cosmetic reasons.

Fluid-filled cysts that come back after several aspirations may need to be removed.

If the testing shows a nodule that is, or might be, malignant (cancerous), your doctor will recommend surgery. (You should discuss special situations, such as pregnancy, with your doctor.) The goal of surgery is to remove as much of the cancerous tissue as possible. If the cancer is found in the early stages when it is still confined to the thyroid gland, the surgery is almost always successful. With papillary cancer, patients usually do well after treatment, even if the cancer has spread to the lymph nodes in the neck.

The surgeon starts by removing one lobe of the thyroid. This specimen is tested during surgery (frozen section) to tell the surgeon whether it is benign or malignant. If it is malignant, most or all of the thyroid is removed. If the cancer has spread, lymph nodes in the neck may also have to be removed. In addition, in patients with either papillary or follicular cancer, radioactive iodine therapy may be needed six weeks after surgery to destroy any remaining cancerous tissue.

What happens after surgery?

After surgery, patients must stay in the hospital for one to three days. They may also need to take some time off from work (one to two weeks for a desk job; three to four weeks for physical labor). Most patients do not have any trouble speaking or swallowing, and they report minimal pain after the surgery. In patients with thyroid cancer, a scan may be done approximately six weeks after surgery to detect any residual thyroid tissue that needs to be treated with radioactive iodine.

Patients with thyroid cancer will need to take thyroid hormone their entire lives. Some patients who have had a noncancerous nodule removed will also be advised to take thyroid hormone pills. These may prevent new nodules from forming in the remaining portion of the thyroid gland.

Anti-Thyroid Drugs

What do antithyroid drugs do?

Antithyroid drugs block pathways leading to thyroid hormone production.

Antithyroid drugs used in this country are Propylthiouracil (PTU) and Tapazole®. Some physicians will recommend antithyroid medication as a first line of treatment to see if the patient is one of the lucky 30% of patients who go into a remission after taking antithyroid medication for one to two years. (Patients are said to be in remission if their hyperthyroidism does not recur after discontinuing the antithyroid drugs.) If antithyroid drugs do not work for the patient, then physicians usually recommend radioactive iodine.

Antithyroid drugs are also used to treat very young children, older patients with heart conditions, and pregnant women. For severe or complicated cases of hyperthyroidism, especially in older patients, PTU or Tapazole® can be given for four to six weeks to bring the hyperthyroidism under better control prior to administering radioactive iodine treatment.

In cases when women are diagnosed with Graves’ disease while they are pregnant, PTU is prescribed. The smallest dose possible is given because the medication does cross over to the fetus. The mother should be checked every three to four weeks during the pregnancy so that the lowest possible dose can be given. Too much PTU can cause fetal goiter, hypothyroidism, and mental retardation.

® Tapozole is a registered trademark of Jones Medical Industries.

Are there any side effects?

Antithyroid drugs cause side effects in about 10% of patients. Reactions can include:

  • skin rash
  • swollen, stiff, painful joints
  • sore throat and fever
  • low white blood count, which can lead to serious infections
  • jaundice (yellow coloring of the skin) and, rarely, liver failure.

Most side effects clear up once the drugs are stopped. If you think you are having a reaction to anti-thyroid drugs, call your doctor immediately.

What can be expected with antithyroid drug treatment?

  • Several pills are taken from one to four times a day, every day for six to 24 months.
  • Some patients complain that the pills have an unpleasant smell and taste.
  • There is usually some symptom relief within one to two weeks. In some cases, it can take several months to relieve symptoms.
  • Antithyroid drugs have a relatively low success rate. While PTU or Tapazole® may correct the problem temporarily or for a few years, the chances of a permanent remission are about 30% once the drugs are stopped.
  • The likelihood of achieving a permanent remission is increased if the patient takes the medication for one to two years.
  • There are side effects in 10% of the people treated with Tapazole® or PTU. These are:
    • skin rash over most of the body swollen, stiff, painful joints
    • sore throat and fever — if this happens, the antithyroid drugs should be stopped immediately and the physician contacted
    • jaundice
    • liver damage, which is fatal in rare cases
  • Because antithyroid drugs pass into breast milk, only PTU in a dosage less than 200 mg a day is advised if the baby is not weaned.
  • Within 15 years, the thyroid gland may burn out, resulting in hypothyroidism, and the patient will need thyroid hormone replacement.

Have more questions? Need more answers? Check our Full Thyroid FAQ

Typical Occurrences Of  Hypothyroidism Edema

Pretibial myxedema is a type of myxedema that occurs on the lower limbs.  It’s typically, although rare, symptomatic of Graves disease, which is an autoimmune type of hyperthyroidism.

Myxedema can also affect people with Hashimoto’s thyroiditis.

Myxedema is commonly associated with more advanced stages of hyperthyroidism and treatment is essential if the fatal myxedema coma stage is to be avoided.  Treatment is usually thyroid hormones administered via IV or nasalgastric tube.

Just what causes some hyperthyroidism patients to develop myxedema and not others is not known.  However, there is plenty of research to suggest that iodine deficiency may play a big part in it.

Donna Morgan

Donna Morgan

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