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Myxedema is a rare skin condition that has a low incidence across the world but can have fatal consequences if left untreated. Read and know what is Myxedema as well as all about its causes, symptoms, diagnosis and treatment.
It is a rare, complicated skin disease that is characterized by inflammation and thickening of the skin. It is known by various other names like “Advanced hypothyroidism” and “Graves’ Dermopathy”. The condition is also often called “Hypothyroidism” although it usually occurs in the advanced stages of that disease.
In British English, the condition is referred to as “Myxoedema”. The condition is more common in women than men.
The disorder is initially characterized by various discomforting symptoms, such as:
- Hoarseness of voice
- Intolerance to cold
- Muscular aches
- Thinning of hair
- Carpal Tunnel Syndrome
In the later stages, suffering individuals typically display other discomforting signs like:
- Weight gain
- Slow speech
- Pale skin
- Swelling of leg (edema)
- Muscular cramps
- Shortness of breath
- Absence of sweat
- Secretion of milk from breast
- Loss of hearing sensations
- Reduced taste sensations
- Lowered sense of smell
- Absence of menstrual periods
- Rise in menstrual bleeding
The symptoms of Myxedema involving the skin are usually present along with other signs of low thyroid hormones. People with persistent cases of reduced thyroid hormone levels generally suffer from:
- Easy weight gain
- Loss of memory
- Mental confusion
- Muscular pain
- Severe fatigue
The symptoms of Myxedema can be too difficult to endure. The condition has a significant impact on the skin which turns coarser and thicker. It generally becomes dryer and retains some amount of water. The skin may also change color to become yellow or orange in appearance. Additionally, there may be deposition of a certain “jellylike” material under some areas the skin. These deposits can lead to inflammation of the skin. In some cases, the disease only impacts the legs and may be referred to as “Partial”. More frequently, however, it affects the entire body thus causing:
- Prominent inflammation
- Roughness of the skin, particularly around the soles of the feet, elbows, knees and palms
The condition usually arises due to Hypothyroidism, a glandular disease occurring due to an inadequate thyroid hormone production. However, it occurs more often in cases where treatment for hypothyroidism is ignored. The disease often arises when the thyroid levels are noticeable low for long durations. The disease is also found to be more common in people with underlying conditions like Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an autoimmune thyroid disorder that makes the immune system within the body view thyroid hormones as foreign particles and produces an abnormal reaction in response. Myxedema may also occur after a person has undergone Thyroidectomy, an operative procedure involving ablation (surgical removal) of the thyroid gland.
In the United States, Hashimoto’s thyroiditis is the most frequent cause of this disease.
It is crucial to diagnose this condition properly as any misdiagnosis can give rise to serious health risks. Lack of enough thyroid hormone for a prolonged duration can make patients slip into a coma. Diagnosis usually involves physical observation and consideration of the symptoms experienced by patients. In the initial stages, physical examination may exhibit signs like:
- Dry skin
- Delayed return of reflexes
- Reduced Heart Rate
In the later stages, physicians may look for symptoms like
- Excessive fluid in lungs (Pleural Effusion)
- Fluid around the heart (Pericardial Effusion)
- Hard swelling of legs
- Increase in heart size
- Inflammation of abdomen (Ascites)
- Low core body temperature
- Puffy face
- Swollen eyelids
- Thickened tongue
- Thinning of eyebrows
- Yellow color of skin
If physicians suspect hypothyroidism as the underlying cause, patients may need to undergo simple blood tests. Doctors may also conduct a Chest X-Ray, which can clearly display enlargement of heart or pleural effusions. An Abdominal Ultrasound examination may be carried out to detect Ascites. MRI scans may also be used to check for an enlargement of the pituitary gland. A pituitary gland enlargement may occur due to Hyperplasia. If Hyperplasia is present, the gland tries to secrete more TSH to compensate for low thyroid hormone secretion by the thyroid glands.
Other findings may include checking:
- Elevated 3rd generation TSH level
- Elevated Cholesterol
- Increase in liver enzymes
- Low Sodium level
- Increase in Antimicrosomal antibodies (if Hashimoto’s Thyroiditis is present)
- Increase in Antithyroglobulin antibodies (for Hashimoto’s Thyroiditis)
- Low or below normal T4 level
Changes in levels of Creatinine kinase, Hematocrit, Glucose and Prolactin are also measured.
Myxedema Differential Diagnosis
The differential diagnosis of this condition involves distinguishing it from other disorders, such as:
- Adrenal insufficiency
- Cold exposure
- Seizure disorder
- Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)
The disease should also be differentiated from renal failure, Liver failure, Nephrotic syndrome and Congestive failure which may be similar to it in superficial appearance. In older individuals, the symptoms of this condition should not be confused with syndromes like Alzheimer’s disease.
The disease is frequently addressed by curing Hypothyroidism, which is its underlying cause and leads to the coarseness and thickening of the skin. The most common treatment involves substituting the reduced thyroid hormones with medications. When administered in appropriate doses, drugs may help stop the progression of the condition altogether.
Treatment of underlying hypothyroidism, which acts as the cause of myxedema, is the most essential part of therapy. However, there also exist other forms of treatment that aim at alleviating the symptoms of the condition. These include:
- Topical corticosteroids – These may be used to reduce the inflammation occurring due to the thickening of skin caused by the disorder.
- Compression stockings – These are also useful in decreasing the swelling arising due to this condition.
- Thyroid replacement hormones – Thyroid hormone supplementation can effectively decrease inflammation and other symptoms arising from Myxedema and underlying hypothyroidism. However, its use depends on the underlying cause of the disorder. However, care should be taken to avoid excessive thyroid hormone replacement as it may cause hyperthyroidism symptoms like sweating, cardiac palpitations and rapid weight loss.
Although thyroid hormone supplementation is considered, thyroid replacement medications are not generally considered for treatment as patients need to use them for the rest of their life.
In cases where patients suffer from autoimmune disorders like Hashimoto’s Thyroiditis, blood monitoring may be needed more or less constantly to ensure that thyroid hormone levels remain within normal ranges.
Treatment measures, other than hormone replacement, should include:
- Antibiotics, if infection is present
- Electrolyte replacement
- Glucose supplementation, particularly in case of low blood sugar
- IV therapy
- Steroid medications
Some of the common medicines that are effective in treating this condition include:
- Levothyroxine (T4) replacement – The medication (Levotabs, Levoxyl, Synthroid) is prescribed at a low dose. The dosage is increased until the level of hormones become stable and stay within the normal range. The dosage of Levothyroxine is based on TSH levels. It may be increased in pregnant women or patients taking bile acid binding resins or Phenobarbital. In older patients, the starting dose should at first be low. It should then be increased at a gradual pace, so as not to precipitate any inherent heart disorder.
- Cytomel – It is a thyroid hormone that works by replacing the thyroid hormones that are naturally present in the body.
- Triostat – It is useful in elevating thyroid levels and addressing the life-threatening symptoms arising from low thyroid levels.
If left untreated, the condition can give rise to acute symptoms. In extreme cases, it can give rise to life-threatening consequences. Mortality for this disease is 20% and is mainly attributed to precipitating and underlying disorders.
Some of the fatal signs and symptoms of this disease include:
- Low blood pressure
- Reduced rate of respiration
- Lowered body temperature
A number of complications can be associated with this syndrome. Some of the major ones among these are:
It is a rare complication arising due to acute underlying Hypothyroidism and also associated to Hypoxia (low oxygen), Hypoventilation (insufficient breathing), Low Blood Pressure, Hypercapnia, low sodium and low core body temperature. It is typically treated as a life-threatening emergency.
Coronary artery disease
Thyroid hormone replacement may precipitate underlying heart disease (i.e., it uncovers heart disease). Therefore, elderly patients are begun at low doses of replacement hormones, and the dose is increased slowly.
Also known as “Myxedema madness”, it is an acute mental disease in which patients suffer from a highly distorted or false sense of reality.
In case of extreme complications, males fail to impregnate and women become incapable of producing offspring.
Underlying Hypothyroidism in pregnant women may result in the birth of a stillborn baby.
If Hypothyroidism is present along with Myxedema, patients may suffer from various other complications like:
- Heart disorders
- Heart failure
- Osteoporosis (weakening and thinning of the bones)
- Birth of a baby with birth defects
- Loss of consciousness
- Vulnerability to infections
Seeking early medical attention can help health care professionals devise a treatment plan that specifically fits the patient and minimizes the risk of acute complications.
The best way to manage this disorder is to prevent its occurrence in the first place. Even though there is no specific way to prevent the condition, screening newborns can be effective in diagnosing its early development. Patients with Hypothyroidism should regularly visit their doctor to undergo blood testing and follow-ups to make sure that the replacement dose is suitable.
Myxedema Risk Factors
The condition is often aggravated due to certain factors. These can be considered as the risk factors of Myxedema and include:
- Exposure to extreme cold
- Inability to take prescribed thyroid medicines
- Use of certain drugs
Females, individuals over 50 years of age, new or old patients of hypothyroidism and individuals suffering from autoimmune disorders are also found to be at risk from this disease.
Myxedema and Lymphedema
Due to similarity of their symptoms, Myxedema is often compared to Lymphedema. However, there are various differences between the two conditions. Although both conditions cause inflammation, swelling is usually asymmetrical in case of Lymphedema. Treatment can check but not cure the condition. However, if thyroid hormone levels are properly regulated, all signs of myxedema can be reduced in intensity and even cured.
It is a form of Myxedema that arises after birth and is exhibited by several features that include slow development and growth. It usually shows up during infancy and is characterized by a type of dry, waxy skin inflammation. The lips and nose often get swollen due to this disorder. The condition is also referred to as “Brissaud’s infantilism”, which is derived from the name of Edouard Brissaud, a noted French physician.
Also known as Thyroid Dermopathy, Infiltrative dermopathy or Localized Myxedema, it affects the Pretibial region and may also spread to other areas of the body, such as
- Dorsum of the foot
The disorder occurs infrequently, as a manifestation of Grave’s Disease. It occurs in maximum 5% of patients with Graves’ disease. Many of these are older in age.
Here are some carefully selected Myxedema images that will provide you with an idea of the physical appearance of its patients. Check these Myxedema photos to know how people with this disorder look like.
Patient suffering from Myxedema before and after treatment
Patient before treatment (left) & after treatment (right)
If you suspect any of your family members to be suffering from acute symptoms of Myxedema, call 911 or seek immediate medical attention. In case of severe symptoms like breathing difficulties, low body temperature or very low blood sugar, patients should be immediately treated by medical professionals or hospitalized. As aforesaid, this is a potentially fatal condition that often requires prompt medical care. Timely treatment can go a long way to ensure health of patients and prevent life-threatening complications.