Hypothyroidism is a condition in which the thyroid gland produces insufficient amounts of thyroid hormones.

Hormones are important to regulate metabolism, heart rate, and body temperature.

Disease advances slowly over time but can also quickly develop post-medication cessation or thyroid removal. Their severity changes from mild to severe.

Common causes of hypothyroidism include:

Hashimoto’s thyroiditis

Iodine deficiency

Thyroid surgery

Radiation therapy

Myxedema occurs when mucopolysaccharides accumulate in skin that causes swelling in face and extremities. It is associated with severe and long-staying hypothyroidism.

Myxedema Coma is rare condition, but severe myxedema is considered as medical emergency.

It shows decompensation of body functions due to severely low thyroid hormone levels.

Common causes of myxedema coma include:

Cold exposure

Stroke

Heart failure

Screening surveys find 5.8% subclinical thyroid abnormalities. Myxedema coma is rare in 0.1% hypothyroidism cases.

Myxedema coma individuals in study were older, on public insurance, and unhoused compared to hypothyroidism.

Global neonatal screening reveals 1 in 4000 newborns have congenital hypothyroidism in some regions.

White and Hispanic populations show increased disease frequency. Incidence is greater in females than males.

Primary hypothyroidism is raises with age in 40 to 50 years old individuals, with a prevalence of 8% to 10% in women over 60 years old.

Thyroid-stimulating hormone stimulates thyroid gland to secrete thyroid hormone from anterior pituitary.

90% to 95% of hypothyroidism is caused due to autoimmune-mediated TSH hypersecretion and goiter formation.

Congenital abnormalities, malignancies, amyloidosis, sarcoidosis, and iodine deficiency these are responsible to cause hypothyroidism in developed countries.

Rare suprathyroidal disorders including hypopituitarism, hypothalamic lesions, and thyroid hormone resistance are rare.

The causes of Hypothyroidism and Myxedema Coma are:

Autoimmune Thyroiditis

Iodine Deficiency

Iatrogenic Hypothyroidism

Thyroidectomy

Pituitary Tumors

Pituitary Surgery or Radiation

Heart Failure

Gastrointestinal Bleeding

Proper diagnosis and timely thyroid hormone replacement lead to complete metabolic function recovery.

Delayed treatment can worsen symptoms in high-risk patients. Mild hypothyroidism patients have better prognosis than severe cases.

Younger patients often recover and can live without symptoms, while older patients may face complications.

Cardiovascular diseases can worsen hypothyroidism prognosis due to added strain.

Collect details including initial symptoms, progression of symptoms, and medical history to understand clinical history of patient.

Cardiovascular examination

Neurological examination

Musculoskeletal examination

Gastrointestinal examination

Subacute to chronic symptoms are:

Fatigue, weight gain, constipation, and cold intolerance

Hypothyroid patients with life-threatening conditions stabilized.

Mechanical ventilation is needed for patients with respiratory drive issue.

Evaluate mental status for life-threatening causes and start IV thyroid hormone treatment if myxedema coma is suspected.

Myxedema coma can cause severe hemodynamic issues and difficulty with airway management.

Manage respiratory failure with mechanical ventilation and treat pulmonary infection.

Patients with myxedema coma improve with passive rewarming and removal of cold or wet cloths.

Manage unstable hypothermic patients with aggressive rewarming measures.

Consult critical care intensivist for myxedema coma to optimize ICU treatment.

Consult endocrinologist to confirm diagnosis and assist in managing patient.

Emergency Medicine

Maintain a warm home or work environment to reduce discomfort feel.

Patients should wear warm and layered cloths to regulate body temperature.

Rich diet and adequate hydration are recommended to improve bowel function.

Create calm and comfortable space for sleep to promote better rest.

Proper awareness about hypothyroidism and myxedema coma should be provided and its related causes with management strategies.

Appointments with an endocrinologist and preventing recurrence of disorder is an ongoing life-long effort.

Emergency Medicine

Liothyronine:

It increases utilization and mobilization of glycogen stores to promote gluconeogenesis.

Levothyroxine:

It promotes gluconeogenesis that is involved in growth development and stimulates protein synthesis.

Emergency Medicine

Hydrocortisone:

It controls rate of protein synthesis to suppress migration of polymorphonuclear leukocytes and fibroblasts.

Emergency Medicine

Specialty: Emergency Medicine

Thyroidectomy is surgical removal of the thyroid gland performed when hypothyroidism is caused due to structural problems in the thyroid.

Fine-Needle Aspiration biopsy may be performed to assess for malignancy or other pathologies in the thyroid nodules.

Endotracheal intubation is used in patients with myxedema coma which shows respiratory failure.

Emergency Medicine

In initial treatment phase, evaluation of symptoms, physical examination, and laboratory test to confirm diagnosis.

Pharmacologic therapy is effective in the treatment phase as it includes use of thyroid products and corticosteroids.

In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical intervention.

The regular follow-up visits with the endocrinologist are scheduled to check the improvement of patients along with treatment response.