Myxedema Coma

What is myxedema coma?

  • Myxedema coma is a condition where long-term hypothyroidism is not treated or is poorly controlled. 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, and body temperature. The thyroid hormones also control how the body uses energy, and affect weight gain and loss.

  • With myxedema coma, the heart, lungs, brain, and other organs do not work correctly. Not all patients who have this condition have myxedema (swelling of the skin) or fall into a coma. Being comatose means the patient is in a sleep-like state, and does not respond to voice, touch, or pain. Myxedema coma affects women over 60 years of age more than other people.

What causes or triggers myxedema coma?

  • Cold weather: This often occurs during cold or winter months.

  • Medicines: Medicines used to treat anxiety, pain, or depression, or not taking thyroid medicines as directed may also cause this condition.

  • Surgery: This may occur in a person with hypothyroidism who has surgery.

  • Trauma and other injuries: Trauma, such as accidents, falls, or burns may trigger an attack.

  • Other diseases or conditions: Having an infection, low blood sugar level, stroke, heart problem, or bleeding in the stomach increase the risk of having this condition.

What are the signs and symptoms of myxedema coma?

As well as the signs and symptoms of hypothyroidism, the patient may have one or more of the following: 

  • Coma or a sleep-like state.

  • Extra fluid and swelling in the arms, legs, ankles, lungs, or around the heart.

  • Puffiness or swelling especially around the eyes.

  • Seizures (convulsions).

  • Sluggishness or problems thinking clearly, such as being forgetful or easily confused.

  • Slow and irregular heartbeats or troubled breathing.

  • Very low temperature.

How is myxedema coma diagnosed?

Caregivers will ask when symptoms or other problems began. Caregivers may ask for information about other diseases, what medicines have been taken in the past, and are being used now. The patient may need any of the following:

  • Physical examination: Caregivers will first check the patient's airway, breathing, and heart beat. They will also check if the patient can lift her hand or move her legs. If no movement is seen, reactions to sound, touch, or pain will be tested.

  • Blood and urine tests: Blood tests check how body organs, such as the liver and kidneys, are working. A sample of urine may also be needed for tests. Blood and urine are checked for infection.

  • Chest x-ray: This is a picture of the lungs and heart. Caregivers may use the x-ray to look for signs of infection or fluid around the heart and lungs.

  • Electrocardiogram: This test, also called an ECG, helps caregivers look for damage or problems in different areas of the heart. Sticky pads are placed on the patient's chest or different parts of the body. These pads are connected to a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in the heart muscle is recorded. Caregivers will look closely for problems with the way the heart is beating.

  • Lumbar puncture: This procedure may also be called a spinal tap. During a lumbar puncture, fluid is removed from around the spinal cord using a thin needle. The fluid is sent to a lab for tests. This test checks for infection, bleeding around the brain and spinal cord, and other problems.

  • Neurologic signs: Caregivers check the eyes, memory, hand grasp, and how easily the patient wakes up. These tests help caregivers learn how the brain is working after an injury or illness.

How is myxedema coma treated?

Treatment will depend on its cause, the patient's health and age, and the level of her thyroid hormones. Thyroid medicines are given to replace and raise her thyroid hormone levels back to normal. If another disease or condition has triggered this, it will also be treated. Medicines may be given to decrease the symptoms and treat problems such as seizures or infections. Medicines or treatments found to be causing myxedema coma may need to be stopped. The patient may also need to be kept warm, be fed through tubes, or breathe through a machine.

Where can I find 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

Care Agreement

You have the right to help plan your family member's or significant other's care. To help with this plan, you must learn about her health condition and how it may be treated. You can then discuss treatment options with her caregivers. Work with them to decide what care may be used to treat your family member or significant other. You have the right to refuse treatment.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.

© 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.

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