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Myxedema coma is an extreme or decompensated form of hypothyroidism and while uncommon, is potentially lethal. [ 1 ] [ 2 ] [ 3 ] A person may have laboratory values identical to a "normal" hypothyroid state, but a stressful event (such as an infection, myocardial infarction , or stroke ) precipitates the myxedema coma state, usually in the elderly.
Myxedema's characteristic physical sign is non-pitting edema, in contrast to pitting edema. [1] Myxedema can also occur in the lower leg (pretibial myxedema) and behind the eyes (exophthalmos). [citation needed] Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma.
Myxedema psychosis is a relatively uncommon consequence of hypothyroidism, such as in Hashimoto's thyroiditis or in patients who have had the thyroid surgically removed and are not taking thyroxine. A chronically under-active thyroid can lead to slowly progressive dementia , delirium , and in extreme cases to hallucinations , coma , or ...
Myxedema coma can be the first presentation of hypothyroidism. People with myxedema coma typically have a low body temperature without shivering, confusion, a slow heart rate and reduced breathing effort. There may be physical signs suggestive of hypothyroidism, such as skin changes or enlargement of the tongue. [19]
Woltman's sign (also called Woltman's sign of hypothyroidism or, in older references, myxedema reflex [1]) is a delayed relaxation phase of an elicited deep tendon reflex, usually tested in the Achilles tendon of the patient. Woltman's sign is named for Henry Woltman, an American neurologist. [2]
[5] [10] Ιn fasting animals, administering leptin reverses NTIS symptoms and restores thyroid hormone concentrations. [5] In obesity, increased leptin increases TSH and T3, and lowers rT3, possibly as an attempt to increase energy expenditure and return to weight set point. [2] Other signals associated with hunger also affect the HPT axis.
Pretibial myxedema is almost always preceded by the ocular signs found in Graves' disease. [3] It usually presents itself as a waxy, discolored induration of the skin—classically described as having a so-called peau d'orange (orange peel) appearance—on the anterior aspect of the lower legs, spreading to the dorsum of the feet, or as a non-localised, non-pitting edema of the skin in the ...
As lymphocytic infiltration progresses, patients may exhibit signs of hypothyroidism in multiple bodily systems, including, but not limited to, a larger goiter, weight gain, cold intolerance, fatigue, myxedema, constipation, menstrual disturbances, pale or dry skin, and dry, brittle hair, depression, and ataxia.