Myxedema - a pathological condition that occurs as a result of improper functioning of the thyroid hormone apparatus and manifested as a sign of hypothyroidism, and clinical symptoms of hyperthyroid.
until recently is the name of the disease as "myxedema" is not used in the practice of endocrinology and largely interpreted as "hypothyroidism".At the present time, given the pathological condition it is a separate nosological form and treatment of the patients had at least one sign of myxedema, a group of doctors involved in various medical specialties.
risk for this disease mainly comprise representatives of the female half of humanity, are postmenopausal, asIt was in this phase marked marked progressive changes in hormonal status.Despite this, men myxedema also found negatively reflected on the state of the sexual sphere.
main etiopathogenetic mechanism of myxedema as a separate nosology, considered insufficient production of thyroid hormones, which in 90% o
Until recently, there was a high incidence of operative myxedema after the benefits of total removal of the thyroid gland without concomitant thyroidin destination.Currently, this form of myxedema etiological practically does not occur in practice endocrinologists as surgical Medical Association revised principles of operative treatment of pathological changes of the thyroid gland, is the use of subtotal resection, instead of the usual thyroidectomy.However, in some situations, Graves' disease in the long course accompanied by the development of fibrous changes in the structures of the thyroid gland, wearing a diffuse character, so that the conditions for the development of signs of myxedema.Pathomorphological myxedema appears in the form of hypoplasia and fibrosis of the stroma of the thyroid gland.
miksematoznye In most cases, the changes are recorded in the disorders of the structures of the thyroid gland, but along with that there are signs of this disease and in the absence of underlying disease.In this case, it sets the diagnosis of "idiopathic myxedema."
Symptoms of myxedema
Until recently it was believed that myxedema develops exclusively in individuals suffering from hypothyroidism, but currently are three main clinical and laboratory forms of this disease: hypothyroid, gipertireodnaya and myxedema with normal hormonal status.Pathological manifestations myxedema start to occur when all nucleated cells of the human body begins to reduce the concentration of thyroxine present, is directly involved in tissue metabolism.
Clinical manifestations of myxedema are quite diverse and at the same time, there is a wide range of pathognomonic symptoms which allow to distinguish this pathology from other clinical entities.Note that in each case there may be a different activity and the intensity of the clinical manifestations, depending on the depth of hormonal imbalance, age of the patient, as well as the presence of concomitant chronic pathologies, contributing for myxedema.
most common symptom in particular myxedema are generalized or limited edema.When miksedeme marked mucoid edema with tight elastic consistency that distinguishes them from edema in patients with renal or cardiac disease.Typical localization edema syndrome is the upper half of the body, especially the face and neck.Sometimes the severity of edema syndrome is so large that suffers not only subcutaneous fat, but also the internal structure (the vocal cords, tracheal rings).Intense swelling is accompanied by violation of the sonority of voice, difficulty breathing and swallowing solid food.The skin in the projection of the modified parts of the body also become altered character, a marked dry skin, brittle hair and nail plates.
signs of central nervous system structures in patients with myxedema is the occurrence of persistent headaches with no clear localization, paresthesias, disturbances of all kinds of sensitivity and mental disorders.A typical sign of myxedema is the development tendency to depressed mood and an overall suppression of the patient's consciousness.
Because thyroid dysfunction is a reflection of the state of all organs and systems of the human body, myxedema has a damaging effect on the structure of the cardiovascular system as well.These changes are manifested in the form of degenerative foci of the heart muscle, cardiac hemodynamics koronaroskleroza and disorders in general.
In a situation where myxedema is accompanied by a pronounced decrease in the production of hormones by the thyroid gland, the patient to the fore signs typical hypothyroid condition.The initial symptoms of the disease state is to reduce disability, drowsiness, inability to perform usual physical work.Patients with myxedema often complain of lack of appetite, disturbance of bowel function, a constant feeling of chills and muscle pain occurrence, as well as stiffness in the projection of large and small joints.
characteristic features of myxedema has young children as thyroid dysfunction negatively affects not only the physical, but also intellectual-mental development of the child.Apart from mental retardation, children with signs of congenital myxedema genesis can be observed gross malformations in the form of congenital deafness and muteness, dwarfism and disproportionality of the body.
Most patients with myxedema, noted a violation of the intestine and the urinary system, which manifests itself in the emergence of a tendency to constipation, urinary retention and sweating.Despite the loss of appetite in patients suffering from myxedema, there is a rapid increase in weight can not be corrected exercise and diet food.Myxedema influence of changes in the reproductive system of women is a violation of the menstrual cycle, as well as the development of secondary infertility.
Long-term course of the disease is accompanied by the development of a coma with a high fatality rate is over 80%.Coma promotes taking certain groups of drugs (psychotropic drugs group neuroleptics), hypothermia.The signs of myxedema coma on a background of a sharp decline in the overall temperature of the reaction, respiratory disorders and the presence of pleural effusion, intestinal obstruction, and acute renal failure.Patients with the severity of the condition to be immediate hospitalization for the purpose of surgical treatment.
separate clinical laboratory form is pretibial myxedema, the occurrence of which is accompanied by excessive production of thyroid hormones.The emergence of this disease often affects women in menopause and in all cases in this group of patients there is an increase in antibody titer to thyroglobulin.Pretibial myxedema is accompanied by the development of characteristic changes to enable an experienced doctor is already in the primary visual inspection to establish the correct diagnosis.
debut in the form of clinical manifestations pretibial myxedema prevalent symptoms of disorders of the skin in the form of the appearance of hyperpigmented areas, pockets of imbibition and skin maceration, with limited dimensions and a typical location in the projection of the front surface of one or both lower legs.Subsequently, hyperpigmented areas are merged into a single diffuse erythema and skin become denser compared with neighboring portions unchanged.The subcutaneous fat accumulates a large amount of mucus of the substrate, resulting in a marked swelling of the distal parts of the lower limbs of a dense structure.In addition to the characteristic changes of the skin, swelling at the location there is a violation of the hair growth.
Suspicion of myxedema, the patient should be directed to determine the background of the disease, which was the agent provocateur of miksematoznyh changes.As such events used laboratory screening status hormonal status of the patient with the obligatory detection levels of hormones produced by the thyroid gland.
as instrumental methods of imaging the thyroid gland is recommended to use an ultrasound scan, which allows detection of focal and diffuse changes in breast tissue.
node discovery destruction of thyroid tissue at any site should be complemented by a puncture of tumors followed by histological examination punctate.
Treatment of myxedema
All clinical forms of myxedema are subject to pathogenetic treatment of substitution drugs.Already during the first days of receiving means of substitution therapy patients reported a significant improvement in health status, is to adjust the manifestations of hypothyroidism.
as the drug of choice for replacement therapy is used Tireoidin a daily dose of 0.3 g orally.This therapy is classified as saturated and to achieve normalization of basal metabolism, it is recommended to transfer patients to the maintenance dose of the drug.It should be noted that the improvement of the patient's condition, as well as the normalization of laboratory parameters is not a criterion for discontinuation of drug substitution therapy as myxedema belongs to the category of progressive chronic pathologies, requiring life-long correction.A feature of hormonal therapy for myxedema is its absolute harmlessness and lack of drug dependence.
thyroidin dose titration is the most difficult situation for the endocrinologist, as the use of high doses can lead to disastrous consequences on the activities of the structures of the cardiovascular system (anginal pain, acute dilatation of the heart cavities and sudden coronary insufficiency).
forecast at miksedeme not be regarded as favorable in all conditions, because the absolute recovery of the patient never comes.However, the constant hormonal drugs to prevent possible complications.Congenital form of myxedema different unfavorable course and prognosis in relation to the normal life.
When pretibial myxedema form should first apply means of local treatment (such as glucocorticosteroid ointments Triderm), eliminating cutaneous manifestations of myxedema.