MYXOEDEMA (Hypothyroidism)

MYXOEDEMA

Ques. 1  What is Myxoedema?

Ans.       It is a diseased condition occurring in adults, marked by a thickening of sub-cutaneous tissue. It may occur endemically or sporadically.

Causes: Sex-commonly female, Age-mostly middle age.

  1. Prolonged iodine therapy.
  2. Idiopathic thyroid fibrosis.
  3. Hashimoto’s disease.
  4. Simmond’s disease.

Ques. 2  What is the Pathology of Myxoedema?

Ans.       The thyroid is small and hard with replacement of fibrosis. There is a protein infiltration of skin and sub-cutaneous tissue :- mucous membranes of the nasopharynx, mouth and ear also in larynx and oesophagus. Coronary blood vessels are sometimes atheromatous and heart is dilated. Testes/ovaries atrophy.

Ques. 3  What are the symptoms and signs of Myxoedema?

Ans.       Symptoms –

  1. Dryness and roughness of skin.
  2. Pain in muscles and joints, clumsy gait, rheumatism.
  • Constipation or obstipation.
  1. Dyspnoea, orthopnoea, dizziness.
  2. Menometrorrhagia, may be amenorrhoea or sterility or habitual abortion.
  3. Polyuria with nocturia.
  • Slowness of thought, loss of memory, drowsiness, hallucination.
  • Sometimes obese inspite of diminished appetite.
  1. Headache, deafness, decreased visual acuity, ataxia, convulsion, facial neuralgia and coma.
  2. Weakness and lethargy.
  3. Low temperature, always require covering, prefer warm weather and room.
  • Pallor of skin.
  • Vertigo, tinnitus impaired hearing, chronic hoarseness or sinusitis.

Signs :

  1. Skin thick, rough, dry and scaly on extremities.
  2. Moderate obesity, non-pitting oedema.
  3. Teeth may decay rapidly.
  4. Thyroid usually small and hard to palpate.
  5. Heat sounds slow (40 to 60 p.m.), distant, muffled.
  6. Hypotension in early stage ; hypertension may develop later.
  7. Diminished deep tendon reflexes.
  8. Puffy features, ‘apple-blossom’ cheeks.
  9. Slow speech with leathery, deep, hollow tones.
  10. Hair dry, sometimes baldness.
  11. Body temperature low (95°F).

Ques. 4  How can we Diagnose Myxoedema?

Ans.       Diagnosis:

  1. Butonol extractable iodine-low.
  2. Serum cholesterol level-high.
  • Urinary 17-ketosteroids-usually low.
  1. Glucose tolerance test-curve tends to be low & flat.
  2. E.C.G.-bradycardia.
  3. B.M.R. – low.
  • Serum protein-bound jodine-low.
  • Radioactive iodine uptake-low.

Differential:

  1. Coronary infarction and insufficiency.
  2. Pituitary myxoedema.
  3. Chronic nephritis.

Treatment:

  1. Thyroxine-Initial dose 0.25 mg. daily gradually increased to minimum maintenance dose.
  2. Laevo-thyroxine sodium (Eltroxin) – Initial does 0.05 mg. daily, gradually increased to minimum maintenance dose.
  • Ventilatory assistance and steroid may be given.
  1. Treatment is to be continued all throughout life.
  2. Symptomatic treatment.
  3. Homoeopathic remedies.

THYROIDINUM – Weakness. Easy fatigue, tendency to fainting, palpitation, cold bands and feet, low blood pressure, chilliness and sensitive to cold, weak pulse.

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