Myxedema

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Introduction

What is myxedema?

Myxedema is a condition marked by thickening and swelling of the skin caused by insufficient production of thyroid hormones by the thyroid gland. The function of thyroid hormones is to regulate your metabolism. Myxedema is associated with other symptoms of underactive thyroid, also called hypothyroidism, including lethargy, weight gain, fatigue, depression, and cold sensitivity, among others.

Hypothyroidism is more common in women, especially those over the age of 50, and can be caused by a viral infection, certain medications, radiation exposure, autoimmune disease, or inherited or congenital disorders. Myxedema is caused by hypothyroidism and occurs more frequently when hypothyroidism is left untreated. Your health care professional can order simple blood tests to determine whether you have hypothyroidism, which can lead to myxedema.

Depending on the cause, myxedema can be treated with thyroid replacement hormones. These medications are effective in eliminating the symptoms that accompany myxedema and hypothyroidism. If you are prescribed thyroid replacement medications, you will probably need to take them for the rest of your life. Left untreated, myxedema can have serious or, rarely, life-threatening complications.

Seek immediate medical care (call 911) for serious symptoms, including very low body temperature, difficulty breathing, low blood sugar, or difficulty thinking clearly, or if you are being treated for hypothyroidism and experience chest pain or heart palpitations.

Seek prompt medical care if you are being treated for myxedema but have mild symptoms that recur or are persistent.

Symptoms

What are the symptoms of myxedema?

Symptoms of myxedema include thickening of the skin and other symptoms associated with hypothyroidism, including fatigue, weight gain, depression, dry skin, and brittle hair, among others. Skin thickening or swelling associated with myxedema is often described as nonpitting edema. In other words, if you press on the skin of the affected area and then remove your finger, you will not see an imprint.

More serious associated symptoms include puffiness in the hands and face and slowing of speech. Rarely, serious or life-threatening symptoms, such as slowed breathing, low body temperature, or unresponsiveness, may be a sign of myxedema coma.

Common symptoms of myxedema

Myxedema is usually part of a larger group of symptoms associated with hypothyroidism. At times any of these symptoms can be severe and include:

  • Brittle hair or fingernails
  • Constipation
  • Decreased sweating
  • Depression
  • Dry or pale skin
  • Fatigue
  • Malaise or lethargy
  • Musculoskeletal pain
  • Sensitivity to cold
  • Thickening of the skin
  • Weakness (loss of strength)
  • Weight gain

Rare or serious symptoms of myxedema

Other symptoms occur more rarely with myxedema, but may indicate a specific cause, type, or more serious condition. These symptoms include:

  • Decreased senses of taste and smell
  • Fullness in the neck (a mass in the neck, called a goiter, is a very rare symptom)
  • Thinning of hair, including eyebrows
  • Slowed speech

Serious symptoms that might indicate a life-threatening condition

In some cases, myxedema can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Chest pain
  • Difficulty breathing or decreased rate of breathing
  • Low blood sugar (hypoglycemia)
  • Low body temperature (hypothermia)
Causes

What causes myxedema?

Myxedema is caused by an accumulation of tissue products, such as glycosaminoglycans, in the skin. Myxedema is almost always a result of hypothyroidism. Specific causes of hypothyroidism that can lead to myxedema include Hashimoto’s thyroiditis, thyroidectomy (surgical removal of the thyroid), and Graves’ disease.

Although myxedema may also be caused by viral-associated hypothyroidism, it is not known to be infectious or contagious.

What are the risk factors for myxedema?

A number of factors increase the risk of developing myxedema. Not all people with risk factors will get myxedema. Risk factors for myxedema include:

  • Age over 50 years
  • Autoimmune disorders (diseases in which the immune system attacks the body’s own tissues as foreign substances)
  • Current or previous hypothyroidism
  • Female gender
  • Surgical removal of the thyroid gland
  • Therapeutic suppression of thyroid gland activity
Treatments

How is myxedema treated?

Myxedema is most often addressed by treating the underlying cause of hypothyroidism that led to the thickening and coarseness of the skin. Medication to replace the reduced thyroid hormones is the most common treatment, and when dosed appropriately, may halt the progression of myxedema.

Treatment of hypothyroidism underlying myxedema

Thyroid hormone replacement therapy is required in most cases of hypothyroidism. These medications replace the thyroid hormone that is lacking in your body and must usually be taken for the rest of your life.

Thyroid hormone replacements, such as levothyroxine (Synthroid, Levoxyl, Levotabs), are prescribed at a low dosage and increased until your hormone levels stabilize in the normal range. Too much thyroid hormone or hormone replacement can cause symptoms of hyperthyroidism (overactive thyroid), including rapid weight loss, heart palpitations, and sweating.

Treatment of myxedema symptoms

Although treatment of the underlying hypothyroidism that causes myxedema is the most important aspect of therapy, other types of treatment target the symptoms of myxedema including:

  • Compression stockings, which may help reduce the swelling associated with myxedema
  • Topical corticosteroids, which may be used to decrease the inflammation associated with skin thickening in myxedema

What are the potential complications of myxedema?

Myxedema coma is a life-threatening complication of myxedema associated with severe hypothyroidism. Myxedema coma is usually the result of untreated severe hypothyroidism in combination with a triggering event, such as an infection.

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of myxedema and hypothyroidism include:

  • Adverse effects of hypothyroidism treatment
  • Giving birth to a baby with birth defects
  • Heart disease
  • Heart failure
  • Infertility
  • Miscarriage
  • Osteoporosis (thinning and weakening of the bones)
  • Susceptibility to infections
  • Unconsciousness and coma
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 30
  1. Hypothyroidism. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001393/
  2. Hypothyroidism. National Endocrine and Metabolic Diseases Information Service. http://endocrine.niddk.nih.gov/pubs/Hypothyroidism/
  3. Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22:1200.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  5. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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