EMCrit Podcast EMCrit Podcast 290 - Myxedema
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Jan 22, 2021 This discussion unveils the intricacies of decompensated hypothyroidism, known as myxedema, especially in elderly women. It highlights distinctive symptoms like bradycardia and hypothermia while differentiating it from thyroid storm. The complexities of diagnosing myxedema are tackled, emphasizing atypical presentations. Listeners also learn about crucial lab testing and management strategies, including the appropriate use of levothyroxine and T3. Additionally, the podcast delves into associated pericardial effusions and the importance of handling them effectively to prevent serious complications.
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Classic Patient Presentation
- A typical myxedema patient is an older woman brought in by family for gradual decline and somnolence.
- Aarti Ban describes them as bradycardic, hypothermic, with leathery non-pitting skin and possible macroglossia.
Normal Vitals Can Be Misleading
- Normal temperature or absence of severe bradycardia doesn't exclude myxedema because illness can mask hypothermia.
- Mental status change is relative to baseline and may be subtle in younger patients.
Rely On Suspicion Not Classics
- Use an index of suspicion combining history, meds, and exam rather than relying solely on classic signs.
- Order thyroid tests when clues exist because myxedema can mimic other conditions.