Myxedema (or mucous edema) is an endocrine disease that occurs in adults with reduced thyroid function or lack of thyroid hormones in the blood. This disease is a consequence of a severe form of hypothyroidism. Also, a similar pathology can be observed with atrophy of the thyroid gland or its removal.

At the same time, there is a reduced content of nuclear cells of the hormone thyroxine, which supports the normal tissue metabolism of all human organs.

This disease can affect people of any age, gender, including children. But, according to statistics, this pathology occurs five times more often in women after the onset of menopause.

The reasons

With myxedema, atrophy of the entire glandular apparatus of the thyroid gland occurs with a complete or partial loss of its intrasecretory function.

The primary form of the disease is an independent disease and is characterized by dysfunction of the thyroid gland. Sometimes with primary myxedema, the normal function of the gland is lost after any diseases (infections or immunodeficiency conditions), injuries, exposure to radioactive iodine.

Most often, the disease occurs after such aggravating factors:

• brain injury or damage;
• infectious diseases (syphilis, tonsillitis, erysipelas);
• mental illness;
• Basedow’s disease (after treatment that significantly damaged the glandular tissue);
• infectious diseases during pregnancy.

Also, a symptom of secondary myxedema can be observed in some diseases of the brain with a disorder of its hypothalamic-pituitary functions.

Post-menopausal women are often at risk for myxedema due to a sharp decrease in hormonal levels.

Also, the causes of this disease may be associated with living in regions with insufficient iodine content.

The appearance of the disease is facilitated by such factors as a lack of iodine in food and water, unfavorable hygienic living conditions (dampness).

The mechanism of the development of the disease

The thyroid gland can be called a mini-factory for the production of the most important hormones for the human body – thyroxine and triiodothyronine. With a decrease in the content of these substances, a hormonal deficiency ( hypothyroidism ) occurs, in which a large amount of substances that retain fluid accumulate in the body. Fluid accumulates in excess in tissues and organs, manifesting itself in the form of various edema and their consequences.

Symptoms

Most often, myxedema develops in patients with hypothyroidism. The modern classification includes the following types of myxedema:

• hypothyroid ;
• hyperthyroid ;
• with normal hormonal status.

Symptoms of the disease depend on the degree of hormonal disorder, age, “bouquet” of chronic ailments.

The most common manifestations of myxedema are:

• mucus-like edema (limited or generalized) in the upper body;
• swelling of the face, neck, vocal cords, trachea;
• violation of swallowing solid food, difficulty breathing;
• change in the sound and timbre of the voice, “weaving” speech;
• dry skin, brittle hair and nails;
• constant chilliness, lowering the general tone;
• persistent headaches.

Depending on the direction of the damaging effect, the disease can cause the following disorders and characteristic symptoms:

• lesions of the nervous system in the form of movement disorders, the presence of paresthesias (hypersensitivity), especially to temperature fluctuations, general lethargy, lethargy, depressive manifestations, memory impairment, slowing down of mental and speech activity, loss of the ability to assimilate and process information;
• lesions of the cardiovascular system are manifested by a slowdown in heart rate, an increase in the size of the heart due to the occurrence of dystrophic changes, the appearance of constant heart pain, edema due to slow blood flow, myocardial dystrophy, cardiosclerosis, heart failure;
• lesions of the digestive system are manifested by a sharp decrease in appetite, nausea or vomiting, the occurrence of gastritis, hypotension of the stomach and intestines, hypokinesia of the biliary tract;
• lesions of the urinary tract in the form of violations of the excretory function of the kidneys with the development of inflammation of the ureters, urethritis, cystitis, hypokinesia of smooth muscles;
• as a result of a decrease in hormone production – muscle pain, a feeling of stiffness in the joints;
• violations of the normal function of the genital area in women and men.
• the most characteristic features of this disease is excessive weight gain, not amenable to correction of physical activity and nutrition.

Women may experience symptoms of impaired fertility with menstrual irregularities and the occurrence of secondary infertility.

The congenital form of the disease in children leads to serious developmental delays (intellectual and physical), congenital pathologies of hearing and speech, dwarfism, and violations of body proportions.

Types of myxedema

Most often, myxedema occurs against the background of a reduced amount of hormones produced by the thyroid gland.

Pretibial myxedema occurs with an increased amount of thyroid hormones. More often this occurs with Graves’ disease. Pretibial myxedema has symptoms such as mucous swelling on the legs, which are determined by the presence of yellow or reddish-brown elevations above the skin. The patient’s skin with this form of the disease is shiny, has peeling, keratinization, with the presence of itchy nodules. There is absolutely no hairiness on the skin.

It happens that it is impossible to establish the cause of this disease. The patient is then said to have idiopathic myxedema. The symptoms of this type of hypothyroidism are no different from the traditional manifestations of myxedema, but the thyroid gland is not enlarged.

Diagnostics

Unfortunately, in many patients, myxedema is not recognized in time. Although people with such symptoms are frequent visitors to the clinic, patients are often mistakenly diagnosed with other diagnoses (cardiosclerosis, neurasthenia, arthritis, chronic nephritis, etc.)

The main diagnostic method for making a correct diagnosis is to determine the amount of thyroid hormones (thyroxine and triiodothyronine) and the level of pituitary hormones (thyroid-stimulating hormone) in the patient’s blood. A sharp decrease in hormones indicates the presence of myxedema disease.

With nodular lesions of the thyroid gland, its ultrasound examination and biopsy for cytological examination are prescribed.

Ultrasound scanning is also used, which allows to identify areas of focal or diffuse lesions of the gland.

Treatment

Depending on the type, the disease can have completely different treatment.

Treatment of the disease in hypothyroid myxedema consists in restoring the deficiency of thyroid hormones. The scheme and doses of drugs are selected individually and with extreme caution, taking into account the basal metabolism and the load on the heart. Most often, patients are prescribed drugs containing thyroid hormones (Triiodothyronine, Thyroidine). It is unacceptable to use high doses of these drugs because of the destructive effect on the heart with the development of acute coronary insufficiency.

With iodine deficiency , iodine-containing drugs are included and the diet is enriched with special products (iodized salt, seafood). To prevent endemic goiter, doctors recommend using iodized salt in everyday cooking.

Pretibial myxedema torments patients with manifestations of itching, therefore, with this type of disease, steroid and anti-inflammatory drugs of general and local action, various ointments and dressings are used.

Treatment of idiopathic myxedema is carried out by methods of symptomatic therapy (with the elimination of disturbing patient manifestations) with the correction of the function of damaged organs and systems.

Forecast

The prognosis for this disease is not favorable, since recovery from it is impossible. However, hormonal drugs can minimize the development of complications of the disease.

The prognosis for congenital myxedema is considered the most unfavorable due to the occurrence of a progressive developmental disorder in children.

Myxedema is a chronic progressive disease. The disease is especially bad for the work of the heart. Throughout the disease, patients need hormonal correction. Replacement therapy for myxedema is carried out for life, since otherwise it is impossible to restore the function of the thyroid gland. Patients are under obligatory dispensary registration with the passage of scheduled examinations twice a year.