Myxedema
myxedema: HOW TO COPE WITH MUCOSAL EDEMA
Myxedema is a clinical syndrome that develops due to hypofunction of the thyroid gland and a pronounced deficiency of hormones that it synthesizes. Myxedema is an edema and is an extreme form of hypothyroidism.
Myxedema is also called mucosal edema, and in ICD-10 it is assigned item E03.9 – unspecified hypothyroidism (or myxedema without further clarification).
CAUSES AND PATHOGENESIS OF MYXEDEMA
The etiology of myxedema can be expressed by primary or secondary hypothyroidism. In the first case, the pathology is due to a decrease in the function of the thyroid gland itself, in the second – a decrease in the action of TSH (thyroid–stimulating hormone, thyrotropin – a hormone synthesized by the pituitary gland), since TSH stimulates the synthesis of thyroxine by the thyroid gland and activates its action.
Primary hypothyroidism may be a consequence of congenital developmental pathologies or inflammatory diseases of the thyroid gland, long-term use of thyrostatics, thyroid cancer, etc. Secondary, as a rule, is observed in diseases of the hypothalamus and pituitary gland.
Due to structural changes in the thyroid gland, the production of thyroid hormones decreases, and this, in turn, slows down the synthesis of proteins, provokes their decay and leads to the accumulation of mucin and hyaluronic acid in the tissues. For this reason, a very peculiar mucous (mucin) edema forms in the tissues and organs.
SYMPTOMS OF MYXEDEMA
Clinical manifestations of myxedema depend on which organs are affected by the pathology. There are both general symptoms of myxedema and specific ones characteristic of cases of damage to certain organs and systems.
Common symptoms include:
pronounced swelling of the skin (including the face) and subcutaneous fat, coarsening of facial features and its puffiness, swelling under the eyes, pallor of the skin in combination with unhealthy blush, reduction of eye slits, often – lack of hair on the outer parts of the eyebrows;
brittle hair, thinning and intense hair loss, brittle nails;
change in the timbre of the voice, slurred speech (due to swelling of the tongue and vocal cords);
heart pain, decreased tone, constant feeling of chilliness, drowsiness and general lethargy;
joint pain and muscle weakness, progressive arthrosis, inflammatory processes in the serous membranes of the pleura, peritoneum, pericardium.
Symptoms of damage to the cardiovascular system:
severe slowing of the heart rate and the development of heart failure, slowing of blood flow in organs and tissues of the body;
an increase in the size of the heart (myocardial activity is reduced and dystrophic changes in muscle tissue are observed, and fluid accumulation forms in the pericardium);
pain in the heart.
Symptoms of damage to the nervous system:
decreased mental activity and intelligence of the patient, general lethargy, slowing down the pace of speech, thinking, reflexes, memory impairment, depressive states;
traffic violations;
a sharp decrease in the tone of the gastrointestinal tract (may be manifested, for example, by chronic constipation);
reduction of sweating.
Symptoms of gastrointestinal tract damage:
sharp decrease in appetite, nausea (with or without vomiting);
hypotension of the intestine or biliary tract, constipation, intestinal obstruction;
an increase in body weight, the appearance of obesity with a balanced or even meager diet and a high level of physical activity.
DIAGNOSTICS AND CLINICAL STUDIES
Diagnosis of myxedema (as well as any other forms of hypothyroidism) is carried out by an endocrinologist. The conclusion is made based on the examination of the patient, the study of anamnesis and the results of clinical studies.
A laboratory blood test helps to determine the level of TSH, thyroxine (T4) and triiodothyronine (T3). In addition, a steadily elevated cholesterol content may indicate mucosal edema.
With myxedema, the capture of radioactive iodine by the thyroid gland and the overall metabolism are also reduced. In some cases, hypochromic or B12-deficient anemia occurs.
TREATMENT OF MUCOSAL EDEMA
Treatment of myxedema is based on hormone replacement therapy and is selected individually in each case. Additionally, a diet can be prescribed. Usually, the patient feels relieved 2-3 weeks after starting taking medications.
It is possible to draw conclusions about the effectiveness of treatment and choose a further strategy only after a few months of course administration of hormonal drugs. Long-term or lifelong treatment is often required, but such measures are well tolerated by most patients and do not entail side effects.
