All About Hypothyroidism Myxedema

All About Hypothyroidism Myxedema

Hypothyroidism myxedema is a very advanced stage of hypothyroidism and is a real medical emergency. Unfortunately diagnosis and beginning treatment at this stage of the disease does not have a good long term prognosis.  Indeed there is a greater than 60% chance that once the disease has progressed to the myxedema coma stage,the patient will die from the disease.  Fortunately, whilst hypothyroidism is common, this advanced stage is not so common. Also, if a patient does go into a hypothyroidism myxedema coma, it’s typically during the winter season.

There are certain factors that can result in a myxedema patient going into coma.  These include:

  • cardiac arrest
  • stroke
  • pulmonary infections
  • surgery
  • trauma
  • hypothermia
  • bleeding in the gastrointestinal system
  • not taking thyroid medicines
  • some types of drugs

Symptoms Of Imminent Hypothyroidism Myxedema

Common symptoms that indicate the potential development of hypothyroidism myxedema include

  • depression,
  • fainting,
  • low body temperature,
  • low heart rate,
  • dry skin,
  • weak eye sight

Low blood levels of sodium may also occur and anaemia may also be present.  Diagnosing hypothyroidism is most accurately done via thyroid function tests that test for blood levels of TSH, T3 and T4.

As previously mentioned, myxedema is a very advanced stage of hypothyroidism.   Most patients suffering from the disease will have sought medical assistance long before they get to this stage. Nevertheless, it can happen and patients who have developed this acute level of hypothyroidism require very precise and vital medical care.

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Hypothyroidism Myxedema Treatment

Common treatments for myxedema coma include supportive care such as ventilation to help them breath along with warmth to raise their core body temperature.   Antibiotics may be administered to ward off potential infection or until it’s established there is no infection present.

Thyroid hormone replacement therapy is also administered. This is usually done intravenously, at least to begin with, because patients at this stage of the disease are often unable to absorb oral thyroid medications. The patient may be given the more metabolically active T3 thyroid hormone in addition to the standard T4 therapy. Normally we convert T4 to T3 in our bloodstream but in myxedema coma patients this process is often impaired.   It can also take several weeks for T4 therapy to start working so the T3 is given to bridge this gap.   This type of treatment needs to be carried out by an endocrinologist (thyroid specialist) because of the complexity of the condition and the complications that can arise. For instance, replacing these hormones too quickly can create stress for the heart and cause arrhythmias, especially in aged patients.

Interesting Questions about Thyroid:

Pregnancy & Thyroid Disease

Why are women more likely to get thyroid disease?

In general, women are much more likely than men to become hyperthyroid or hypothyroid and to get Hashimoto’s thyroiditis. The reason for this is uncertain.

Women are also more vulnerable to autoimmune diseases. Two of the most common thyroid diseases, Hashimoto’s thyroiditis and Graves’ disease, are caused by problems with the body’s immune system. Normally, the immune system defends the body against germs and viruses. In autoimmune diseases, the system attacks the body’s own tissues. Diseases of the immune system tend to run in families.

What about thyroid disease and pregnancy?

Hyperthyroidism or hypothyroidism can affect a woman’s ability to become pregnant. They may also cause a miscarriage if they are not quickly recognized and properly treated.

Women who become pregnant may not notice signs of thyroid disease because similar symptoms can occur in a normal pregnancy. For example, patients may feel warm, tired, nervous, or shaky. In addition, enlargement of the thyroid (goiter) commonly occurs during pregnancy.

A pregnant woman is treated differently than is a non-pregnant woman or a man. For example, radioactive materials commonly used in diagnosing and treating many thyroid diseases are never used in pregnant women. The timing of a biopsy or surgery for a thyroid nodule and the choice of drugs for hyperthyroidism may be different in a pregnant woman. These issues require careful consultation with your doctor.

What is postpartum thyroiditis?

Postpartum thyroiditis is a temporary form of thyroiditis. It occurs in 5%-9% of women soon after giving birth (postpartum period). The effects are usually mild. However, the disease may recur with future pregnancies.

The symptoms usually last for six to nine months. First, the damaged thyroid gland may release its stored thyroid hormones into the blood, causing hyperthyroidism. During this time, you can develop a goiter, have a fast heart rate, and feel warm or anxious. Then, a few months later, you will either return to normal or become hypothyroid. Hypothyroidism occurs because the thyroid has been damaged and its hormone reserves used up. If this happens, you may feel tired, weak, or cold. The hypothyroidism usually lasts a few months until the thyroid gland completely recovers. Occasionally, the hypothyroidism may be permanent.

How do doctors test for thyroid disease during pregnancy?

As with any disease, it is important that you watch for the early warning signs of thyroid disease. However, only your doctor can tell for sure whether or not you have the disease. Your doctor may examine:

  • your history and physical appearance
  • the amount of thyroid hormones, thyroid stimulating hormone (TSH), and thyroid antibodies in your blood.

How is thyroid disease treated during pregnancy?

Pregnancy places some limits on the treatments which you can receive, because your doctor must also look out for the safety of your child. A common treatment for hyperthyroidism is radioactive iodine, but it must be avoided by women who are pregnant or nursing a baby. Surgery to remove a goiter or cancer may also be delayed until after the pregnancy. However, needle aspiration biopsy of a thyroid nodule may be safely done during pregnancy.

Treatments which may be used for thyroid disease during pregnancy include:

Postpartum thyroiditis may or may not be treated during the hyperthyroid stage, depending upon its severity. If the patient later becomes hypothyroid, her doctor may prescribe thyroid hormone pills.

How is Hyperthyroidism Treated?

The basic goal of treatment is to return thyroid hormone levels to normal.

Hyperthyroidism makes the body work too fast because there is too much thyroid hormone in the blood. Graves’ disease is the most common cause of hyperthyroidism. Graves’ disease occurs because of a problem in the body’s immune system: antibodies are produced that overstimulate the thyroid gland.

Patients who are hyperthyroid from taking too much thyroid hormone need only to have their dosage properly adjusted.

Patients whose hyperthyroidism is caused by transient thyroiditis usually do not require any of the treatments described below, since their condition gets better on its own.

Treatment for hyperthyroidism from Graves’ disease, toxic autonomously functioning thyroid nodule, or toxic multi-nodular goiter may include one or more of the following:

Radioactive iodine (I131)

Radioactive iodine shrinks an enlarged thyroid or toxic nodule or nodules that are making too much thyroid hormone. This treatment is safe and is widely used in adults with hyperthyroidism.

* Radioactive iodine (I131) is the treatment of choice for the majority of the endocrinologists in this country. It is an effective, simple, safe way to treat patients with Graves’ disease or other forms of hyperthyroidism. Patients often have fears and misconceptions about using radioactive iodine.

* Studies have been done since the 1940’s on patients receiving this treatment. Treated patients, their children, and their grandchildren do not have an increased incidence of cancer, leukemia, etc.

* There are no increased instances of birth defects in children born to mothers who have had this treatment and waited the recommended time before becoming pregnant. (Pregnancy should be avoided for at least six months after the treatment.) As a matter of fact, fertility is often restored to women whose infertility is due to hyperthyroidism. Treating the disease also lessens the chance of miscarriage.

* Pregnant women should not be given radioactive iodine for any reason. If a patient has any doubt as to whether she is pregnant, treatment (and testing) with radioactive iodine should be delayed.

* Hospitalization is not required in order to treat hyperthyroidism with radioactive iodine.

* Radioactive iodine treatment ablates the thyroid gland (turns it into something like a dried-up raisin). Patients wishing to avoid destruction of the gland should know that the thyroid gland frequently “burns out” within 15 years even without treatment.

* Radioactive iodine does not cause a person to gain weight. However, because Graves’ disease increases the metabolism, patients should keep in mind that they cannot continue to eat the way they did while hyperthyroid. Because of changes in the metabolism after hyperthyroidism is treated, many patients will gain weight . This weight can be lost through diet and exercise once the thyroid levels are normalized.

Antithyroid drugs

Propylthiouracil (PTU)

Antithyroid drugs, such as propylthiouracil (PTU) and methimazole (Tapozole®), are used in patients with Graves’ disease and, less commonly, in other hyperthyroid patients

Surgery (thyroidectomy)

In some cases beta-blocking drugs are prescribed to treat the symptoms of hyperthyroidism while waiting for one of the above treatments to work.

Your doctor will be able to discuss the benefits and risks of each treatment.

Many patients treated for hyperthyroidism become hypothyroid. They will need to take thyroid hormone pills for the rest of their lives. In addition, they will need to see their doctor at least once a year.

® Tapozole is a registered trademark of Jones Medical Industries.

What About My Child?

If you or a blood relative has Hashimoto’s thyroiditis or Graves’ disease, there is a chance that your children will inherit the problem. These diseases are also linked to other autoimmune conditions, such as premature gray hair, diabetes mellitus, arthritis, and patchy loss of skin pigment (vitiligo). You should tell your child’s doctor, so that the appropriate examinations can be performed.

Also, one out of every 4,000 infants is born without a working thyroid gland. If the problem is not corrected, the child will become mentally and physically retarded. Therefore, all newborns in the United States are tested for the disease. Once the problem is discovered and corrected, the child can grow up normally.

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

Preventing Hypothyroidism Myxedema

Someone with hypothyroidism myxedema may experience moodiness, short breath and perhaps swelling in hands and feet.  They may also be restless, lethargic, depressed, have difficulty sleeping, experience weight gain, feel unexplained pain in various areas of their body, and lose eyebrow and scalp hair. Hypothyroidism can also affect the gastrointestinal system, leading to other associated health problems.

If you suspect you may be suffering from hypothyroidism you must seek medical attention sooner rather than later. This is not a disease to be ignored or messed around with. The prognosis when caught early is excellent but if prescribed medications are not taken, the condition will worsen and potentially develop into hypothyroidism myxedema. Therefore, the simple and short answer to how best to prevent hypothyroidism escalating to myxedema is to take your prescribed medications as directed!

Feeding The Thyroid Gland To Prevent Hypothyroidism

The thyroid requires iodine for the manufacture of the thyroid hormones T3 and T4.   Whilst iodine deficiencies are rare in developed countries they are nonetheless more prevalent than they used to be. One reason is the discontinued use of iodine to clean milk vats and milk processing equipment. The iodine residues left in the equipment were absorbed by the milk and found their way into the finished products, providing a good source of iodine.

There are other good sources of dietary iodine available or you could consider a thyroid supplement like Thyromine.  Seafood is particularly rich in iodine and many products like breads and iodized salt are fortified with iodine.  You don’t need much though. The recommended daily intake for teenagers and adults is 150 micro grams per day. Children under 9 years of age should have 90 micro grams per day and those from 9 – 13 need 120 micro grams per day. Pregnant and breastfeeding woman require more.

When you visit your doctor he (or she) will order certain blood tests in order to establish your level of thyroid activity.  If the results indicate hypothyroidism, they will discuss treatment options with you.  This will include both dietary considerations as well as medications.   Once beginning treatment for hypothyroidism it is essential that you take your medications as prescribed and go for regular check ups.