What Is Myxedema?

Myxedema is a medical term used to describe a rare but life-threatening situation caused by untreated hypothyroidism.

The thyroid gland is a small organ—about the size of two thumbs—located at the front of your neck. This small gland is responsible for providing your body with a variety of thyroid hormones. 

Altered mental status, hypothermia, and changes in the skin are key signs of myxedema—or severe hypothyroidism. Myxedema can lead to a coma and death if hypothyroidism is left untreated. 

Since hypothyroidism is four times more common in women, statistically speaking, myxedema coma is more common in women. In fact, 80% of people diagnosed with myxedema are women.

Myxedema Symptoms

When your body lacks thyroid hormone, your heart rate slows down, your blood pressure lowers, and your temperature decreases—sometimes as low as in the 80s.

When your thyroid is underproducing, you’ll notice it in little ways throughout your entire body. For example, you may:

• Feel tired
• See drier skin than usual
• Notice your hair is brittle
• Experience constipation

It’s important to know, you don’t just end up in a myxedema coma one day. The symptoms are often slow to build. Fortunately, most people with hypothyroidism will notice something is off and seek medical attention before getting to the coma phase.

If you begin to transition from hypothyroidism to myxedema, you will have many, if not all, of the following symptoms:

• Low body temperature
• Triggering infection or illness
• Shallow or slow breathing
• Low blood pressure
• Pulse below 60 beats per minute
• Slow or no reflex
• Low sodium levels
• Low blood sugar
• Decreased mental status

Causes

Myxedema coma can occur for a variety of reasons. However, all cases start when hypothyroidism goes untreated.

The thyroid hormone regulates a wide variety of the body, including the brain, heart, skin, intestinal system, metabolism, and more. When hypothyroidism goes untreated, these body functions begin to slow or shut down. 

If you experience any of the following situations with untreated hypothyroidism, your chance of experiencing myxedema coma increases:

• Infections such as pneumonia, urinary tract infections, or the flu
• Surgery
• Stroke
• Certain drugs or medications like tranquilizers, beta-blockers, barbiturates, and narcotics
• Severe burns
• Low blood sugar
• GI bleeding
• Exposure to cold weather or hypothermia

All of these situations put a greater demand on your body’s metabolism and, in return, deplete your body of any thyroid hormone your body stores.

Diagnosis

Most people who seek care for myxedema coma are unaware of what’s going on around them. They are unable to answer simple questions and may not understand why they are in the hospital. In many cases, they are unable to explain their medical history or answer questions the medical staff may ask, making a quick diagnosis much more challenging.  

Myxedema coma is primarily diagnosed after receiving lab results. In cases where a healthcare provider suspects myxedema, they may start treatment before receiving lab results, to save time and hopefully reverse the body’s desire to shut down. 

The most common labs to run when experiencing myxedema symptoms are:

• Thyroid-stimulating hormone (TSH)
• Complete blood count (CBC)
• Arterial blood gas (ABG)
• Cortisol

You may also have an electrocardiogram (ECG) done to check for irregular heart rhythms—this is common with thyroid problems. 

Treatment

With myxedema, your doctor has four primary considerations for your treatment plan: hormone replacement therapy, steroid therapy, supportive care, and identifying what caused the situation in the first place.

Hormone Replacement

The most critical step to reversing myxedema is through thyroid hormone therapy. This hormone therapy will be in the form of a synthetic thyroid medication like Synthroid or levothyroxine. 

After starting thyroid hormone therapy, you will notice a significant turnaround within one to two days. 

Steroid Therapy

With severe cases of hypothyroidism, adrenal insufficiency will tag along. Adrenal insufficiency can be potentially deadly. Therefore, it’s crucial to treat adrenal insufficiency with steroids until the body regains balance. 

Supportive Care

Supportive care includes warming the body and rewarming the body if needed. Since the body is struggling to keep the temperature high enough, hypothermia is a significant concern. 

There may also be a need for assistance from a ventilator to help with breathing.

Identify and Treat the Cause

What transpired that resulted in a myxedema coma? Is there an underlying infection or drug addiction? Did the patient recently have surgery?

Finding out what caused someone to spiral into a myxedema coma will help determine if further treatment is needed beyond myxedema. For instance, there could be an underlying urinary tract infection requiring treatment.

A Word From VeryWell

Myxedema is a rare but dangerous condition. At this time, there are no at-home, over-the-counter, or homeopathic treatment options available for myxedema.

If you or someone you know is experiencing myxedema symptoms, seek emergency medical care immediately. Most people who quickly receive proper treatment can fully recover from myxedema and only require treatment for low thyroid hormone afterward.