Myxoedema, formerly Gull's disease (Latin myxoedema), occurs in hypothyroidism, most often in the form of Hashimoto's disease. What are the causes and symptoms of myxedema? How is his treatment going?

Myxoedema , formerly Gull's disease (Latin myxoedema), occurs inhypothyroidism , which most often takes the form of the disease Hashimoto.Hypothyroidism can also result from the removal of a gland. It can also be secondary, due to damage to the pituitary gland or due to the lack or insufficient secretion of hypothalamic thyreoliberin. The symptoms of the disease depend on the pace of its development and the patient's age.

Myxedema - causes

The effect of the deficiency of thyroid hormones manifests itself in the reduction of basal metabolism by approx. 35-45%, which is expressed by a moderate increase in body weight (despite reduced appetite), cold intolerance and lower body temperature. One of the effects of slowing down the metabolic processes is myxedema. It occurs mainly in the area of ​​significant accumulation of flaccid connective tissue - facial features are thickened, eyelids and hands are swollen. This is due to the deposition of fibronectin and hydrophilic glycosaminoglycans in the subcutaneous tissue, the synthesis of which is inhibited by T3 (Triiodothyronine). In the case of untreated hypothyroidism, a life-threatening condition may occur - coma in the course of myxoderma coma (myxoderma coma). It can be caused by an existing disease.

Myxedema - symptoms

In addition to edema, symptoms such as:

  • hypothermia ( <30 st.C, nawet do 24 st. C)
  • significant bradycardia
  • hypoxemia with hypercapnia (due to poor ventilation)
  • hypoglycemia
  • hyponatremia
  • dementia or coma

Shock develops. Muscle tone is reduced but seizures can occur. Tendon reflexes are weakened. Symptoms of other comorbidities (e.g. pneumonia or other infections, heart attack, gastrointestinal bleeding) may appear.

But before myxedema occurs, herald symptoms appear. The concentration of C-reactive protein (one of the markers of inflammation) and homocysteine ​​increases. Cholesterol levels increasetotal, LDL fraction, triglycerides. Intellectual functions are impaired, memory deteriorates, headache, drowsiness, slowing down, sometimes there is also depression.

Cardiovascular dysfunction is one of the most severe symptoms. Systolic and diastolic insufficiency of the heart develops, and typically bradycardia or other severe arrhythmias develop. There is a decrease in exercise tolerance, and in the advanced stage of hypothyroidism, effusions in the pleural cavities, the pericardium and peritoneum. Congestive heart failure, pulmonary edema, and cardiac tamponade are very rare.

In terms of the digestive system, the dominant problems are constipation and flatulence, and in drastic cases paralytic obstruction. Weakened gallbladder motility promotes the formation of urolithiasis.

In severe hypothyroidism, intestinal absorption may be impaired due to the deposition of mucopolysacchards in their walls. Symptoms of the disease can also be seen in the functioning of the reproductive system, in the form of menstrual disorders, decreased libido, ovulation disorders and an increased risk of miscarriage and premature birth.

Men also have decreased libido and erectile dysfunction. 30-40% of patients develop anemia. In patients with hypothyroidism, the skin is dry, scaly, thick and cool. May have a bluish or yellowish tinge. The function of the sebaceous and sweat glands is impaired. Characteristic is thinning of scalp hair, loss of eyebrows, eyelashes, loss of sexual hair.

Myxedema - diagnosis

The diagnosis of hypothyroidism includes laboratory tests, imaging tests, and ECG. Blood tests show a decrease in the concentration of free thyroid hormones, an increase, normal or decreased TSH (depending on the cause), high titer of anti-TPO and anti-Tg antibodies (in Hashimoto's disease).

In hypometabolic coma, low levels of FT4 are observed, usually slightly elevated TSH, elevated cholesterol, anemia, sometimes hyponatraemia, and mild hypercalcemia.

An ultrasound of the thyroid gland is performed - an image depending on the cause of hypothyroidism. In advanced disease, ultrasound of the abdominal cavity may show fluid in the peritoneal cavity, X-ray of the lungs - pleural fluid and enlargement of the heart shape. In case of cardiovascular symptoms, echocardiography and ECG may be useful.

You may need a thyroid scintigraphy. The diagnosis of metabolic coma is usually determined by symptoms, but other possible causes have been ruled outcomas.

Myxedema - treatment

The treatment of hypothyroidism involves supplementation with the hormone Thyroxine (L-T4). The principle is to start treatment with small doses and gradually increase them. With proper regulation of the hormonal level, metabolic processes accelerate and symptoms slowly subside.

Treatment of metabolic coma is carried out in the intensive care unit and is always multi-directional. It consists in administering L-T4 intravenously, and after improvement - orally. The principle of slowly increasing the dose does not apply. Adequate lung ventilation (intubation and respiratory support is usually necessary), electrolyte balance and adequate intravenous fluid intake should be ensured. Co-morbidities should be treated. Active heating of a hypothermic patient is contraindicated.

Myxedema - prevention

In order to prevent hypothyroidism and its sometimes life-threatening consequences, regular and proper substitution treatment is essential. It is also important to properly treat systemic diseases that coexist with hypothyroidism, as they may induce a hypometabolic coma.

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