This is a rare and life-threatening complication of hypothyroidism (underactive thyroid gland). It is called myxedema coma, and it occurs when the body does not produce enough thyroid hormones for a few years. In some cases, it may also happen if you already have hypothyroidism and do not get treatment. Furthermore, myxedema coma is a medical emergency and may cause the following symptoms. Examples include slow heart rate, hypotension (low blood pressure), and others.
While the name of this complication contains the medical term “coma”, people do not go into it. That’s why sometimes, it is called myxedema crisis. It is very important to understand that this complication is a medical emergency, which means people who experience it need immediate treatment in the intensive care unit (ICU). If you suspect a loved one has symptoms of myxedema coma, immediately call 911 or go to the nearest emergency room (ER).
What Are The Symptoms of Myxedema Coma?
People who experience this complication usually experience the following symptoms. These include:
- Changes in mental status
- Confusion and disorientation
- Coma or unconsciousness
- Edema (swelling)
- Hypotension (low blood pressure)
- Slow heart rate
- Shallow breathing
- Hypothermia (low body temperature)
Immediately seek medical help if any of the previous symptoms occur. Otherwise, this complication may lead to death.
Causes and Risk Factors
One of the most common causes of myxedema coma is not getting treatment for an underactive thyroid gland for years. Some people do not even know they have hypothyroidism. If you develop this condition and leave it untreated, the body does not have enough thyroid hormone, which is vital for the heart, muscles, brain, and metabolism. Furthermore, there are some known triggers. Examples include:
- Cold temperatures
- Infections (such as pneumonia)
- Heart failure
- Stroke
- Surgery or trauma
- Weakness
- Fatigue (extreme tiredness)
- Some medications (including Lithium, Amiodarone, sedatives, and tranquilizers)
- Not taking medicines to treat hypothyroidism exactly as recommended by your doctor
While anyone can develop myxedema coma, doctors have identified some factors that may increase your risk of developing it. Check some of them below:
- A long history of untreated hypothyroidism
- Age – Females over 60 years old are more likely to develop this hypothyroidism complication compared to other people.
- Living or staying in a cold area for long periods (approximately 90% of diagnosed myxedema coma cases occur in winter weather)
- Autoimmune disorders (such as Hashimoto’s thyroiditis)
- Prior thyroid surgery (such as thyroidectomy)
What Are The Long-term Effects of Myxedema Coma?
This medical emergency may cause other complications without immediate treatment. Check some examples below:
- Shock and hypotension
- Bradycardia (abnormal heart rate)
- Pericardial effusion (excessive fluid in the sac around the heart muscle)
- Hypoventilation
- Respiratory acidosis (this complication occurs when there is an accumulation of acid in the blood)
- Coma
- Seizures
- Bleeding disorders
- An increased risk for infections (such as pneumonia)
This document does not contain a full list of complications, but if you get treatment for myxedema coma as soon as possible, they may not occur. In addition, people who get treatment for hypothyroidism may prevent this myxedema coma. If you suspect or have symptoms that resemble hypothyroidism, do not hesitate to visit your doctor for a diagnosis and treatment.
Diagnosis
First, doctors perform a physical examination to check for abnormalities linked to the disease. Thereafter, they may also ask some questions about your symptoms and medical history to gather more information about your disease. However, to confirm or exclude myxedema coma, physicians will perform the following tests and procedures. These include:
- Blood tests – These tests are often used to confirm hypothyroidism and check white blood cell count, blood sugar, and electrolytes.
- ABG (arterial blood gas)
- Electrocardiogram (ECG or EKG) to check heart rhythm
- Lumbar puncture (also known as a spinal tap)
Treatment
Usually, treatment for this hypothyroidism complication takes place in the ICU. In most cases, people with myxedema coma will receive the following options. Examples include:
- IV (intravenous) medicines – People often receive levothyroxine (T4) to increase thyroid hormone levels. Sometimes, doctors may also give the patients liothyronine (T3) and hydrocortisone to replace the hormones that the adrenal gland does not produce.
- IV (intravenous) fluids – They help stabilize the body and relieve the symptoms.
- Supportive care – It often includes a warm blanket for hypothermia, oxygen therapy or mechanical ventilation to help you breathe, or antibiotics to treat or prevent bacterial infections.
Frequently Asked Questions
When should I see my healthcare provider?
Immediately go to the nearest emergency room or call 911 if you or a loved one experiences symptoms that resemble myxedema coma, including confusion, swelling, and breathing problems.
What can I expect if I have a myxedema coma?
This is a medical emergency that requires immediate treatment. Otherwise, it may lead to death. Generally, myxedema coma is fatal in about 2 to 6 out of 10 people. While some people recover from this complication within a few days, others may need weeks to recover completely. It often depends on the severity of the condition, overall health, and the patient’s response to treatment.
How rare is myxedema coma?
This complication occurs very rarely, and it affects about 0.22 per 1 million people each year.
Can myxedema coma be prevented?
One of the best ways to prevent myxedema coma is to properly manage hypothyroidism. Taking thyroid hormone replacement medications exactly as prescribed and attending regular medical checkups can significantly reduce the risk of developing this life-threatening complication.
Who is most likely to develop myxedema coma?
Myxedema coma most commonly affects older adults, especially women over the age of 60 who have long-standing, untreated hypothyroidism. People with autoimmune thyroid diseases, previous thyroid surgery, or those exposed to severe cold temperatures may also have a higher risk.
Is myxedema coma always associated with a coma?
No. Despite its name, many people with myxedema coma do not become completely unconscious. Instead, they may experience severe confusion, extreme drowsiness, slowed thinking, or significant changes in mental status before progressing to more serious symptoms.
How quickly does myxedema coma develop?
In most cases, myxedema coma develops gradually over time as hypothyroidism worsens. However, an infection, surgery, trauma, cold exposure, or certain medications can trigger a fast decline and cause symptoms to become severe within a short period.
Can medications increase the risk of myxedema coma?
Yes. Certain medications, including sedatives, tranquilizers, lithium, and amiodarone, may contribute to the development of myxedema coma in people with poorly controlled hypothyroidism. Always discuss your medications with your healthcare provider if you have thyroid disease.
What is the prognosis after treatment for myxedema coma?
The outlook depends on how quickly treatment begins and whether complications develop. Many people improve with prompt intensive care, thyroid hormone replacement, and supportive treatment. Delayed treatment can increase the risk of serious complications and death.
Will I need lifelong treatment after recovering from myxedema coma?
Most people who experience myxedema coma have underlying hypothyroidism and will require lifelong thyroid hormone replacement therapy. Regular follow-up appointments and blood tests are important to ensure thyroid hormone levels remain within a healthy range. Ask your healthcare provider if you have any other questions.
