Myxedema Coma

WHAT YOU SHOULD KNOW:

  • Myxedema coma happens as a result of long-term, poorly controlled or untreated hypothyroidism. Hypothyroidism occurs when the thyroid gland makes too little or no thyroid hormone. The thyroid gland is a butterfly-shaped organ that is located in the front part of the neck. Thyroid hormones help control body functions such as heart rate, growth, body temperature, and weight gain or loss. With myxedema coma, the heart, lungs, brain, and other organs no longer work correctly. This condition may be caused by cold weather, surgery, certain medicines, or trauma, such as accidents, falls, or burns. Other causes include not taking thyroid medication as prescribed, having an infection, low blood sugar level, stroke, heart problem, or bleeding in the stomach.

  • With this condition, not all patients have myxedema (swelling of the skin) or fall into a coma. In addition to signs and symptoms of hypothyroidism, a patient may also have a very low temperature, problems thinking clearly, a slow and irregular heartbeat, or trouble breathing. Caregivers will ask about the patient's symptoms, other diseases and medicines, and do a physical exam. Blood and urine tests, chest x-ray, electrocardiogram (ECG) and a lumbar puncture may also be needed. Treatment will depend on the cause of the myxedema coma. Medicine may be given to bring thyroid hormone levels back to normal, decrease symptoms or treat the cause. The sooner that myxedema coma is treated, the better chance the patient has of returning to normal.

AFTER YOU LEAVE:

Medicines:

  • Keep a written list of the medicines to take, the amounts, and when and why they are given. Bring the list of these medicines or the pill bottles when you see her caregivers. Do not give the patient any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to her caregivers.

  • Always give the medicine as directed by the patient's caregivers. Call her caregivers if you think the medicines are not helping or are causing side effects. Do not stop giving the medicines until you discuss it with the patient's caregiver.

Follow-up visit information:

Keep all appointments. Write down any questions that you or the patient may have. Ther way you will remember to ask these questions during the next visit.

Blood sugar checks:

The patient's blood sugar may need to be checked several times each day by using a glucose monitor (glucometer). A glucometer is a small device that tells how much sugar is in the blood. her finger is pricked to draw blood and the blood is put into a glucose monitor. Ask the patient's caregiver for more information about using a glucose monitor and what the blood sugar level should be.

Diet and nutrition:

The patient may be given nutrition through the mouth, vein (IV), or a tube. A caregiver, called a dietitian, may talk to you about the patient's home feeding and nutrition.

  • If the patient has no problems eating through the mouth, she may need to eat foods that are low in fat, cholesterol, or salt. She may be given thickened liquids to drink or soft foods to eat. Her diet should include a variety of healthy foods such as fruit, vegetables, breads, dairy products, and protein.

  • If the patient can not eat food, she may be fed through a tube. A nasogastric tube is a tube put through the nose and down into the stomach. A tube may also go directly from the outside of the body into the stomach. This is called a gastrostomy tube. Total parenteral nutrition (TPN) is feeding given through a large IV. These feedings supply protein, sugar, vitamins, minerals, and fat (lipids). Ask the patient's caregiver how to care for these tubes.

Keeping the patient warm:

Use a blanket when the patient's temperature is low. A warm room may also help the patient keep warm. Remove clothes that are wet or cold, and do not use heated (electric) blankets.

Respiratory care:

  • Chest physiotherapy: This is used to loosen up sputum (mucus) in the lungs and help the patient breathe easier. It is done by tapping over the patient's ribs (chest, back, and side). Once the fluid is loosened, the patient may need to cough it up. If she cannot cough up mucus, suction may be used to remove it.

  • Deep breathing and coughing: If possible, have the patient breathe deeply and cough. Deep breathing opens the tubes going to the lungs. Coughing helps to bring up sputum from the lungs to be spit out.

  • Suction: A small tube is used to help suck out the mucus in the patient's mouth, nose, and lungs. This tube will be inserted in the mouth or nose. Suction may need to be done more than once to make sure all of the mucus is out.

Skin care:

A special mattress called an egg crate or air mattress may be put on the patient's bed. The patient will need to be turned often if she cannot move by herself. Doing this will help prevent bed sores.

For support and more information:

Myxedema coma is a life-changing condition for you, your family, and especially the patient. You, those close to you, or the patient may feel angry, sad, or frightened. These feelings are normal. Talk to the patient's caregivers, your family, or friends about your feelings. Contact the following for more information:

  • American Thyroid Association
    6066 Leesburg Pike, Suite 550
    Falls Church , VA 22041
    Phone: 1- 703 - 998-8890
    Phone: 1- 800 - 849-7643
    Web Address: www.thyroid.org
  • The Hormone Foundation
    8401 Connecticut Ave.
    Chevy Chase , MD 20815-5817
    Web Address: www.hormone.org
  • Endocrine and Metabolic Diseases Information Service
    National Institutes of Health
    6 Information Way
    Bethesda , MD 20892-3569
    Phone: 1- 888 - 828-0904
    Web Address: http://www.endocrine.niddk.nih.gov

CONTACT A CAREGIVER IF:

  • The patient has a temperature.

  • The patient develops new symptoms.

  • You see a pressure sore on the patient's skin.

  • You have questions or concerns about the patient's condition, medicine, or care.

SEEK CARE IMMEDIATELY IF:

  • The patient fainted or had a seizure (convulsion).

  • The patient has chest pain or trouble breathing all of a sudden.

  • The patient has swelling in her eyelids, arms, legs, ankles, or feet.

  • The patient has trouble thinking clearly or becomes very weak.

  • The patient's lips or fingernails turn blue or white in color.

  • The patient's signs and symptoms return or become worse.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Myxedema Coma (Discharge Care)

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