Myxedema

The designation Myxedema comes from the Scottish doctor William Miller Ord, who in 1877 found the connection between the occurrence of tissue swelling and the underactive thyroid (hypothyroidism). Myxedema is a symptom of various thyroid disorders and occurs all over the body or in local areas. In its worst form, myxedema coma, it can even lead to death.

What is myxedema?

Myxedema is a hormone-related pathological accumulation of glycosaminoglycans in the subcutaneous tissue. These substances are sugar-protein compounds that have a high water-binding capacity. They are insufficiently broken down in patients with myxedema. If the whole body is affected, it is a generalized myxedema (classic myxedema).

If the tissue swellings are limited to the edges of the shins and the dorsum of the foot, medicine speaks of localized pretibial myxedema. Even with this swelling, no dents are left when pressure is applied to the affected skin area. Patients with myxedema have puffy, swollen skin. In addition, the surface of the skin feels cool and is rough and dry. In generalized myxedema, the entire body appears puffy.

If the underlying hypothyroidism is not treated in time, under certain conditions (exposure to cold, stressors, overexertion), myxedema coma can occur. Myxedema causes impaired consciousness or even coma and is fatal in 30 percent of cases if the emergency doctor is not called immediately.

causes

Generalized myxedema is caused by an underactive thyroid. Doctors assume that a disruption of the T3 hormone is responsible for the reduced breakdown of the muco-polysaccharides hyaluronic acid and chondroitin sulfate in the connective tissue. In the localized form of myxedema, the subcutaneous fibroblasts are stimulated by the TRAKs that cause the overactive thyroid.

Both thyroid disorders are congenital or acquired and have a probability of 1 in 5,000. Hashimoto's thyroiditis - a form of underactive thyroid - is an acquired autoimmune disease. Surgical removal of thyroid tissue can also cause hypofunction. If a person consumes too much iodine over a long period of time, the thyroid gland may become underactive.

The failure or insufficient release of TSH due to a disease of the pituitary gland can also cause myxedema. An overactive thyroid can occur, for example, through an overdose of anti-thyroid drugs - which in turn triggers a thyroid hormone deficiency. The administration of lithium to treat depression can also lead to hyperfunction. The myxedema coma can arise from the ingestion of pain and sedatives, cold and also spontaneously.

Classic myxedema can be recognized by swollen facial wrinkles, swollen tongue and bloated upper eyelids. This causes the eyes to take on a slit shape. The slowed metabolism causes symptoms such as freezing, tiredness and fatigue, dry, dull hair, hair loss, dry skin and a hoarse voice.

But also constipation, muscle stiffness, weight gain despite decreased appetite, muscle cramps, hearing loss, forgetfulness, depression and, in women, a very heavy menstrual period are signs.

Sometimes it also leads to anemia, high blood pressure and high cholesterol levels. The problem is that many of the symptoms are typical of other diseases and general states of exhaustion. Therefore, it often happens, especially in older patients, that an underactive thyroid is not recognized.

You are therefore particularly at risk of developing a myxedema coma, which manifests itself in the form of breathing difficulties, slow heartbeat (bradycardia), hypothermia, intestinal paralysis and pericardial effusion (accumulation of fluid in the pericardium). The poor supply of nutrients and oxygen causes the patient to fall into a coma.

The following symptoms are characteristic of localized pretibial myxedema: swelling on the sides of the shins and on the back of the feet, cravings, nervousness, sweating, diarrhea, and palpitations.

Diseases with this symptom

• Hashimoto's thyroiditis
• Graves disease

• Autoimmune disease
• Pericardial effusion

• Hypothyroidism
• Anemia

Diagnosis & course

Myxedema is easily recognizable externally. The underlying thyroid disorders can be diagnosed using blood samples. The TSH value, the free thyroxine (fT4) - the value is usually too low - and possibly the T3 value are determined. In hypothyroidism, the TSH value is very high - unless a TSH deficiency is the cause of the hypofunction.

When should you go to the doctor?

Myxedema should always be treated by a doctor. If this disease is not treated, the patient may even die in the worst case. The symptoms of myxedema are very diverse and in most cases do not provide any direct information about the disease. In most cases, depression, fatigue and hair loss occur. However, those affected also suffer from hearing loss, muscle cramps, or weight gain.

Should these complaints arise, a doctor must be contacted immediately. Difficulty breathing or cold extremities can also be symptoms of myxedema. It is not uncommon for patients to appear nervous and stressed and suffer from sweats and cravings. The patient's resilience also decreases enormously and thus leads to a reduced quality of life. Even if the person concerned is not sure about the symptoms, a doctor should definitely be consulted. This can diagnose whether it is actually a myxedema.

Doctors & therapists in your area

Treatment & Therapy

The treatment of myxedema depends on the underlying disease. If the cause is hypothyroidism, the doctor will permanently prescribe L-thyroxine to replace the deficient T4. If the patient is only slightly underactive, the patient can also take homeopathic constitutional remedies such as Calcium Carbonicum, Graphites, Pulsatilla or Barium Jodatum.

It also helps to switch the body to a low-carbohydrate and low-acid diet and to season the dishes with sea salt containing iodine. If you prefer Schüssler salts, then Magnesium Phos. No. 7, Kalium Bromatum No. 14 and Kalium Jodatum No. 15 are recommended. In hyperthyroidism, anti-thyroid drugs are administered that curb hormone production and - as a sustainable treatment - radioiodine therapy is carried out.

In Graves' disease, most of the goiter is surgically removed. In myxedema coma, T3 is given in the form of triiodothyronine or T4. The patient is also given an infusion of glucocorticoids, glucose and salts. If his body is severely hypothermic, it is carefully warmed up.

Outlook & forecast

As a rule, myxedema is very easy to recognize from the outside, so that treatment can be carried out relatively quickly and, above all, early. In many cases, people become constipated or gain weight. Women often suffer from heavy menstrual bleeding. The patients experience impairment of the sensory organs so that, for example, seeing and hearing can only be more difficult. Psychological problems such as depression can also occur.

Myxedema can also carry signs of a common cold, causing patients to complain of cold extremities or headaches. These symptoms can interfere with the patient's everyday life and thereby reduce the quality of life. For many people, everyday life is no longer possible.

In many cases, myxedema can be treated relatively easily and does not lead to further symptoms. Treatment takes place by taking a drug. A healthy diet low in carbohydrates and acids is also suitable here.

If myxedema occurs in young children or newborns, it can also be treated with medication. Here, too, the treatment does not lead to any further complications.

prevention

Prevention of hypothyroidism is not possible unless it is caused by a lack of iodine. At the end of the first week of life, a blood sample is taken from newborns and a thyroid hormone test is carried out. If there is a deficiency, they are treated with medication to prevent cretinism.

You can do that yourself

How can patients make life with their diagnosis as easy and comfortable as possible? First of all, it is important to follow your doctor's advice and prescriptions. But the often heard tip "a lot of exercise" should also play a role in everyday life because it is of fundamental importance for everyone.

Many find welcome support in self-help groups, because they receive valuable information and helpful insights in exchange with other affected persons. Conversations and cultivating contacts also keep the soul life in balance. Soul and body need attention right now. For example, recipes and experiences with special foods that can increase well-being are exchanged among like-minded people. A healthy diet with fruit and vegetables and an adequate supply of proteins and calcium always form the basis for an increase in well-being. And some of them report on special treatment methods such as radioiodine therapy.

A clarifying discussion can be held with the attending physician at the next visit to the doctor. As a professional, he will find the right remedy. Because every patient has their own individual medical history and requires a treatment method tailored to them.