Myxedema

Myxedema is a medical word for very severe thyroid disease. Doctors use it in two ways. First, it can mean extreme, long-standing hypothyroidism, when the body has had very low thyroid hormone for a long time and many organs start to fail. Second, it can mean a special kind of swelling in the skin and tissues caused by thick, jelly-like substances that build up when thyroid hormones are abnormal. This swelling is usually firm and does not leave a pit when you press it, so it is called “non-pitting edema.” NCBI+1

In severe hypothyroidism, myxedema can progress to a medical emergency called myxedema coma or myxedema crisis. In this state, the brain, heart, lungs, and other organs slow down so much that the person can become confused, very cold, very sleepy, and may even stop breathing properly. This condition is rare but life-threatening and needs urgent care in a hospital. Cleveland Clinic+2NCBI+2

Other names for myxedema

Myxedema has several other names or related terms that you may see in books or articles. It is sometimes spelled “myxoedema,” especially in the United Kingdom. Doctors also use terms such as “severe hypothyroidism,” “decompensated hypothyroidism,” “myxedema coma,” and “myxedema crisis” when the condition is very advanced. When the swelling is mainly in the lower legs in people with Graves’ disease, it is called “pretibial myxedema” or “thyroid dermopathy.” Wikipedia+2Cleveland Clinic+2

Types of myxedema

Myxedema can appear in different ways. Doctors often think about the following main types: MDPI+3NCBI+3Wikipedia+3

1. Generalized hypothyroid myxedema – this is the classic form in long-standing untreated hypothyroidism, with puffy, non-pitting swelling of the face, hands, and feet, dry skin, and many slow body functions.

2. Myxedema coma or crisis – a very severe, decompensated stage of hypothyroidism where body temperature, blood pressure, breathing, and brain function become dangerously low.

3. Pretibial myxedema (thyroid dermopathy) – thick, raised, sometimes scaly plaques and swelling on the shins in people with Graves’ disease, usually linked with hyperthyroidism but still called myxedema.

4. Periorbital myxedema – swelling around the eyes, making the eyelids look puffy and heavy, often seen in advanced thyroid disease.

5. Congenital or cretinous myxedema features – in babies and children with severe untreated hypothyroidism, growth and brain development can be delayed and tissues can show myxedematous swelling.

Causes of myxedema

Myxedema usually develops slowly after years of thyroid hormone problems. It is most often linked to hypothyroidism, but certain forms are linked to hyperthyroidism. Below are 20 important causes or contributing factors. MSD Manuals+4NCBI+4Mayo Clinic+4

1. Long-standing untreated Hashimoto’s thyroiditis – Hashimoto’s disease is an autoimmune condition in which the immune system attacks the thyroid gland. Over many years the gland is destroyed and thyroid hormone levels fall very low. If this is not treated with hormone tablets, severe hypothyroidism and myxedema can develop. Mayo Clinic+1

2. Total thyroid removal without enough hormone replacement – some people have surgery to remove all or most of the thyroid gland for cancer or large goiters. If they do not receive enough lifelong thyroid hormone after surgery, they can develop very low hormone levels and then myxedema. Thyroid.org+1

3. Radioactive iodine treatment not followed by proper monitoring – radioactive iodine can destroy the thyroid in hyperthyroidism. Without regular blood tests and correct replacement doses afterward, patients may become severely hypothyroid and eventually develop myxedema. Thyroid.org+1

4. Congenital absence or poor development of the thyroid – some babies are born without a normal thyroid gland. If this is not found and treated early, they can develop severe hypothyroidism and myxedematous features as they grow. Mayo Clinic+1

5. Severe iodine deficiency – iodine is needed to make thyroid hormones. In regions with very low iodine in food and water, long-term deficiency can cause hypothyroidism and myxedema in adults and developmental problems in children. Wikipedia+1

6. Long-term use of antithyroid drugs without proper adjustment – medicines used to treat hyperthyroidism, such as methimazole, can sometimes oversuppress the thyroid. If the dose is too high and not adjusted, the person may swing into severe hypothyroidism. sborl.es+1

7. Drugs that block thyroid hormone production or conversion – medicines like amiodarone, lithium, some immune drugs, and some cancer drugs can interfere with thyroid hormone synthesis or change T4 to T3. In susceptible people this can lead to marked hypothyroidism and myxedema. AAFP+1

8. Radiation to the neck – radiotherapy for head and neck cancers can damage the thyroid gland. Years later, this may cause severe hypothyroidism with myxedematous changes if not monitored. AAFP+1

9. Pituitary tumors or surgery (central hypothyroidism) – if the pituitary gland is diseased or removed, it may not make enough TSH, the hormone that tells the thyroid to work. This can cause very low thyroid hormone and myxedema if not treated. NCBI+1

10. Hypothalamic disease – damage to the hypothalamus in the brain can reduce TRH, a hormone that drives TSH and thyroid function. Severe, long-term central hypothyroidism from this cause can also lead to myxedema. NCBI+1

11. Postpartum thyroiditis that becomes chronic – some women develop thyroiditis after pregnancy. If thyroid failure becomes permanent and is not treated, they may slowly progress to severe hypothyroidism and myxedematous swelling. Mayo Clinic+1

12. Infiltrative diseases of the thyroid – rare conditions such as sarcoidosis, hemochromatosis, or amyloidosis can invade the thyroid tissue, impair hormone production, and eventually lead to severe hypothyroidism with myxedema. MDPI+1

13. Severe, chronic autoimmune thyroid damage of any cause – any long-lasting inflammatory process that slowly destroys thyroid tissue, if not recognized and treated, can lead to end-stage hypothyroidism and myxedema. Mayo Clinic+1

14. Graves’ disease with pretibial myxedema – in Graves’ hyperthyroidism, antibodies can stimulate skin cells in the legs to produce extra mucopolysaccharides, causing thickened plaques called pretibial myxedema, even when thyroid hormone may be high rather than low. Wikipedia+2Cleveland Clinic+2

15. Severe infection in a person with poorly controlled hypothyroidism – pneumonia, urinary infection, or sepsis can overwhelm a body already slowed by low thyroid hormone and may trigger myxedema coma. AAFP+2NCBI+2

16. Exposure to very cold environments – hypothyroid patients have difficulty keeping warm. Prolonged cold exposure can push someone with severe hypothyroidism into myxedema crisis with hypothermia and organ failure. Cleveland Clinic+2NCBI+2

17. Major surgery, trauma, or heart attack – big physical stresses can unmask or worsen underlying severe hypothyroidism and push the person into decompensation with myxedema coma. AAFP+2NCBI+2

18. Use of sedatives, narcotics, or anesthetic drugs – these medicines can slow breathing and mental state. In someone with severe hypothyroidism, they can further depress the brain and lungs, acting as a trigger for myxedema coma. AAFP+2Medscape+2

19. Stopping thyroid hormone tablets for a long time – some patients with known hypothyroidism stop taking their replacement pills. Over months or years this can lead to very low hormone levels and finally myxedema. AAFP+2MedlinePlus+2

20. Sepsis or multi-organ failure in a person with hypothyroidism – when a very sick patient already has low thyroid hormone, the combined stress of sepsis or organ failure can tip the balance and produce myxedema coma. Thyroid.org+2NCBI+2

Symptoms of myxedema

The symptoms of myxedema reflect very slow body processes and fluid-filled tissues. They can build up gradually and may be overlooked until they become severe. Medical News Today+4NCBI+4Healthline+4

1. Extreme tiredness and lack of energy – people feel exhausted all the time, may sleep a lot, and still wake up tired because the body’s metabolism is very slow and cells do not produce enough energy. Mayo Clinic+1

2. Sensitivity to cold – the person feels cold even in warm rooms, needs extra clothing or blankets, and cannot tolerate cold weather because thyroid hormone helps the body generate heat. Mayo Clinic+1

3. Noticeable weight gain – body weight increases even though appetite may be low. This is due to slower metabolism, fluid retention, and sometimes less physical activity. Mayo Clinic+2AAFP+2

4. Dry, rough, and pale skin – the skin becomes thick, cool, and scaly. Reduced blood flow and slowed skin turnover cause roughness and pallor, and sweat production is often reduced. Healthline+2Medical News Today+2

5. Non-pitting swelling of face and limbs – puffiness around the eyes, lips, hands, and feet does not leave a dent when pressed. This non-pitting edema is due to mucopolysaccharides that hold water in the tissues and is a classic sign of myxedema. ScienceDirect+2Osmosis+2

6. Hoarse, slow, or deep voice – the voice may sound rough or deeper than before. Thickening of the tissues in the throat and vocal cords, along with fluid build-up, cause this change. Wikipedia+2MDPI+2

7. Slow heart rate and sometimes low blood pressure – the pulse becomes slow, and blood pressure can drop, especially in coma. The heart muscle is less active because thyroid hormones normally help it beat stronger and faster. Cleveland Clinic+2NCBI+2

8. Shortness of breath and shallow breathing – breathing may become slow and weak. In severe cases, carbon dioxide can build up and oxygen levels fall, which is dangerous and can lead to respiratory failure. Cleveland Clinic+2NCBI+2

9. Constipation and bloating – the digestive tract moves more slowly. Stools become infrequent and hard, and the abdomen may feel swollen or uncomfortable. Mayo Clinic+2AAFP+2

10. Muscle weakness and cramps – muscles may feel heavy, tired, and achy. People can have trouble climbing stairs or lifting objects. This comes from low energy, altered muscle enzymes, and sometimes nerve involvement. NCBI+2AAFP+2

11. Poor memory and slow thinking – patients may feel “foggy,” forget things easily, or need more time to think and respond. The brain’s activity slows when thyroid hormone is very low. NCBI+2NCBI+2

12. Depression or low mood – sadness, lack of interest, and emotional slowing are common. Hypothyroidism can affect brain chemicals and mood, and myxedema often appears with significant depression. Mayo Clinic+2AAFP+2

13. Confusion and drowsiness progressing to stupor or coma – in myxedema coma, the person may be very sleepy, disoriented, or unresponsive. This happens because the brain is not getting enough oxygen, energy, and proper temperature control. Cleveland Clinic+2NCBI+2

14. Very low body temperature (hypothermia) – body temperature can drop well below normal. The skin feels cool, and shivering may be reduced. This is a key sign in myxedema coma and is related to the inability to generate heat. Cleveland Clinic+2NCBI+2

15. Heavy or irregular menstrual periods and reduced fertility – women may have menstrual cycles that are heavy, prolonged, or irregular, and may have trouble becoming pregnant. Thyroid hormones strongly affect reproductive hormones. Mayo Clinic+2AAFP+2

Diagnostic tests for myxedema

Doctors diagnose myxedema by combining clinical signs with specific tests. These tests fall into physical exam, manual bedside assessments, lab and pathological tests, electrodiagnostic tests, and imaging tests. AAFP+4NCBI+4Medscape+4

1. Vital signs assessment (physical exam) – the doctor measures body temperature, heart rate, blood pressure, breathing rate, and oxygen saturation. In myxedema, they may find hypothermia, slow pulse, low blood pressure, and slow breathing, which signal severe disease. Cleveland Clinic+2NCBI+2

2. Skin, hair, and facial inspection (physical exam) – the clinician looks for pale, dry, thick skin, coarse hair, and puffiness around the eyes and face. These visible changes support the diagnosis of severe hypothyroidism with myxedema. Healthline+2ScienceDirect+2

3. Palpation of skin and tissues (physical/manual test) – the doctor presses the skin on the legs, hands, or face to see if swelling is pitting or non-pitting. Firm, rubbery swelling that does not pit suggests myxedematous edema rather than ordinary water retention. ScienceDirect+2Osmosis+2

4. Thyroid gland palpation in the neck (physical/manual test) – the neck is gently felt to check the size, texture, and presence of nodules in the thyroid. The gland may be small, enlarged, or scarred, giving clues to the cause of hypothyroidism. Mayo Clinic+2AAFP+2

5. Cardiovascular examination (physical exam) – listening with a stethoscope may reveal a slow heart rate, muffled heart sounds, or signs of fluid around the heart (pericardial effusion). These findings are common in severe hypothyroidism and myxedema. NCBI+2ScienceDirect+2

6. Lung examination (physical exam) – the doctor listens to the lungs for shallow breathing, crackles from fluid, or poor air movement. These can show that respiratory muscles and lung function are depressed in myxedema coma. Cleveland Clinic+2NCBI+2

7. Neurologic and mental-status exam (manual test) – simple questions and tasks are used to judge alertness, memory, and thinking speed. Confusion, slow responses, or reduced consciousness point toward severe decompensated hypothyroidism. NCBI+2NCBI+2

8. Deep tendon reflex testing (manual test) – the doctor taps tendons at the knee or ankle with a hammer. In hypothyroidism, the reflex may be slow to relax, a classic sign that supports the diagnosis of myxedema. NCBI+2AAFP+2

9. Glasgow Coma Scale (GCS) scoring (manual test) – this bedside scoring system measures eye opening, speech, and movement to grade consciousness. A low score in a hypothyroid patient suggests myxedema coma and guides urgency of treatment. NCBI+2ScienceDirect+2

10. Serum thyroid-stimulating hormone (TSH) test (lab test) – this blood test measures how much TSH the pituitary is making. In primary hypothyroidism and myxedema, TSH is usually very high, while in central causes it may be low or normal despite severe disease. NCBI+2AAFP+2

11. Free thyroxine (free T4) level (lab test) – free T4 is the main thyroid hormone in the blood. In myxedema, free T4 is usually markedly low, confirming severe hypothyroidism and helping to judge how serious the deficiency is. NCBI+2AAFP+2

12. Free triiodothyronine (free T3) level (lab test) – free T3 is the active thyroid hormone. It is often low in myxedema and helps complete the picture, especially in complex or central thyroid disorders. NCBI+2NCBI+2

13. Thyroid autoantibody panel (lab/pathological test) – tests such as anti-TPO and anti-thyroglobulin antibodies look for autoimmune attack on the thyroid. A positive result supports diagnoses like Hashimoto’s thyroiditis as the underlying cause of myxedema. Mayo Clinic+1

14. Serum electrolytes, especially sodium (lab test) – low sodium (hyponatremia) and low serum osmolality are common in myxedema coma and may explain confusion and seizures. Electrolyte tests also show kidney and fluid balance status. Medscape+2NCBI+2

15. Complete blood count (CBC) (lab test) – CBC may show anemia and sometimes changes in white blood cells or platelets in severe hypothyroidism. These findings support the diagnosis and help rule out other illnesses. NCBI+2AAFP+2

16. Serum lipids (lab test) – cholesterol and triglycerides are often elevated in hypothyroidism. A high lipid profile in a person with other signs of myxedema supports a chronic low-thyroid state and helps assess heart risk. Mayo Clinic+2AAFP+2

17. Arterial blood gas (ABG) analysis (lab test) – ABG measures oxygen, carbon dioxide, and blood pH. In myxedema coma there may be high carbon dioxide and low oxygen, showing hypoventilation and the need for breathing support. NCBI+2Medscape+2

18. Kidney and liver function tests (lab test) – these tests show whether other organs are being affected. Abnormal creatinine, liver enzymes, or other markers can indicate multi-organ involvement in severe myxedema. NCBI+2AAFP+2

19. Electrocardiogram (ECG) (electrodiagnostic test) – ECG records the heart’s electrical activity. In myxedema there may be slow heart rate, low-voltage signals, or rhythm problems, helping to judge how much the heart is affected. NCBI+2Medscape+2

20. Thyroid ultrasound and other imaging (imaging tests) – ultrasound can show gland size, nodules, or scarring, and may help identify autoimmune or infiltrative causes. In coma, chest X-ray, brain CT or MRI, and echocardiography may be used to look for heart fluid, brain changes, or other complications. AAFP+3Mayo Clinic+3NCBI+3

Non-pharmacological treatments for myxedema

Myxedema means very severe, long-lasting hypothyroidism where the body is extremely low in thyroid hormone and can even go into myxedema coma, a life-threatening emergency. Supportive (non-drug) care does not replace thyroid hormone, but it protects the brain, heart, lungs, and kidneys while medicine starts to work.NCBI+1

1. Gentle warming and temperature support
   People with myxedema often feel very cold and can become dangerously hypothermic. Doctors use warm blankets, warmed IV fluids, and a warm room instead of aggressive heating to slowly raise body temperature. This careful warming helps the heart and blood vessels adjust slowly and lowers the risk of sudden low blood pressure or irregular heart rhythm during treatment.SpringerLink+1

2. Oxygen therapy and breathing support
   Severe hypothyroidism can slow breathing and weaken the respiratory muscles, so extra oxygen or even a breathing machine (ventilator) may be needed. Giving oxygen supports the brain and other organs while thyroid hormone levels are corrected. In myxedema coma, careful monitoring of breathing and blood gases in an intensive care unit is standard supportive care.NCBI+1

3. Careful IV fluid and blood-pressure management
   Myxedema can cause low blood pressure, slow heart rate, and fluid shifts in the body. Doctors give IV fluids slowly and check blood pressure, urine output, and electrolytes often. This prevents both dehydration and fluid overload, which can worsen heart failure or swelling around the lungs and heart.journalmc.org+1

4. Treatment of infections and other triggers
   Myxedema coma is often triggered by infection, surgery, heart attack, trauma, or stopping thyroid medicines. Doctors search for triggers with blood tests, chest X-ray, urine tests, and other studies. They treat infections quickly (for example with antibiotics) and correct other problems like low blood sugar or low sodium, which helps stabilize the patient while thyroid hormone therapy works.NCBI+1

5. Heart monitoring and cardiac protection
   Severe hypothyroidism stresses the heart and blood vessels. Patients are often placed on continuous heart monitors to watch for slow heart rate, heart block, or arrhythmias. Blood pressure, oxygen level, and urine output are checked frequently. Doctors increase thyroid hormone doses slowly in older people or people with coronary artery disease to avoid provoking chest pain or heart attack.AAFP+1

6. Electrolyte and sodium correction
   Myxedema can cause low sodium, low blood sugar, and other electrolyte changes that affect the brain and muscles. Doctors correct these gently with IV fluids and careful replacement. Slow correction is important, especially for sodium, to reduce the risk of brain swelling or nerve damage.NCBI+1

7. Nutrition and gut support
   Severe hypothyroidism slows digestion and can cause constipation, poor appetite, and weight gain. Patients who cannot eat safely may need tube feeding. A balanced diet with enough protein, vitamins, minerals, and fiber supports healing and helps the body respond to thyroid hormone replacement, while avoiding sudden heavy meals that the slow gut cannot handle.AAFP+1

8. Skin and pressure-sore care
   People with myxedema may move very little, feel weak, and have cool, dry, swollen skin. Nurses check the skin often, keep it clean and moisturized, and change positions regularly. This reduces the risk of pressure sores, skin infections, and cracks, which can all complicate recovery and increase infection risk.NCBI+1

9. Gentle physical therapy and mobilization
   As the patient stabilizes, simple movements in bed, sitting up, and slow walking help prevent blood clots, pneumonia, and severe muscle loss. Physical therapists adjust activities to the patient’s energy level and heart status and slowly increase exercise as thyroid levels normalize.turkarchpediatr.org+1

10. Mental health and cognitive support
    Myxedema can cause memory problems, depression, confusion, or coma. As the brain recovers, patients may still feel slow, anxious, or sad. Supportive counseling, simple explanations, and family involvement help with emotional recovery. Long-term follow-up with mental health professionals may be helpful if mood problems or cognitive changes persist.NCBI+1

11. Avoiding unnecessary sedatives
    Sedatives, sleeping pills, and some pain medicines can be very dangerous in myxedema because the brain and breathing are already slowed. Doctors usually avoid or minimize such drugs and choose safer options. This reduces the risk of respiratory depression and coma in these fragile patients.NCBI+1

12. Passive rewarming in ICU setting
    In intensive care, core temperature is monitored closely. Passive rewarming (blankets, warm room) is often preferred to aggressive heating. This approach allows careful control of body temperature and reduces hemodynamic stress on the heart and circulation in people with myxedema.SpringerLink+1

13. Careful medication review
    Many drugs can interact with thyroid hormone or worsen hypothyroid symptoms. Doctors review all medicines, including over-the-counter drugs and herbal products, and adjust them. This is important for drugs that affect heart rhythm, blood thinning, or thyroid hormone absorption.AAFP+1

14. Education on lifelong therapy
    Non-pharmacological care also includes clear education. Patients and families are taught that hypothyroidism is usually a lifelong condition and that thyroid hormone tablets must be taken every day, ideally on an empty stomach and away from certain foods and medicines. Good understanding helps prevent future severe episodes.AAFP+1

15. Fall prevention and safety
    Weakness, dizziness, and slow reflexes can increase the risk of falls. Simple steps like keeping the bed low, using rails, good lighting, and assistive devices help protect patients as they regain strength and balance during recovery from myxedema.NCBI+1

16. Sleep and day-night rhythm support
    People with thyroid problems often have poor sleep and fatigue. In hospital, staff try to maintain a regular day-night schedule by reducing nighttime noise and encouraging activities during the day. Good sleep supports healing and improves mood and energy.AAFP+1

17. Smoking cessation support
    Smoking worsens cardiovascular risk and may worsen some autoimmune thyroid diseases. Counseling, nicotine replacement (if appropriate), and follow-up support help patients stop smoking, which supports better long-term outcomes with thyroid disease.AAFP+1

18. Monitoring for depression and anxiety
    Even after thyroid levels normalize, some patients still have low mood or anxiety. Routine screening and referral to a mental health professional help identify and treat these problems early with therapy or medicines if needed, improving overall quality of life.AAFP+1

19. Regular follow-up and lab monitoring
    Non-pharmacologic care also includes regular clinic visits and blood tests for TSH and free T4. These visits allow dose adjustment of thyroid hormone, checking for side effects, and ongoing education about lifestyle and adherence, which prevents relapse into severe hypothyroidism.AAFP+1

20. Family and caregiver involvement
    Because severe hypothyroidism can affect memory and understanding, involving a trusted family member or caregiver in appointments and hospital care improves safety and adherence. They can help remind the patient to take medicine, watch for danger signs, and arrange follow-up care.NCBI+1

Drug treatments for myxedema

Drug therapy is the key treatment for myxedema. The main goal is to replace missing thyroid hormone, and, in myxedema coma, this is done urgently, often in an intensive care unit. All doses and choices must be decided by a specialist doctor; self-treatment is not safe.NCBI+1

1. Levothyroxine sodium injection
   Levothyroxine sodium injection is specifically indicated by the FDA for the treatment of myxedema coma. It is given intravenously in the hospital to quickly raise thyroid hormone levels when the gut cannot absorb tablets. Doctors use a loading dose followed by daily IV doses, while carefully monitoring heart function and vital signs to avoid sudden strain on the heart.FDA Access Data+1

2. Oral levothyroxine sodium tablets (generic)
   For most stable patients with hypothyroidism, oral levothyroxine tablets are the standard first-line treatment. They are synthetic T4 hormone and are taken once daily on an empty stomach, usually in the morning. The dose depends on body weight, age, and heart health, and is adjusted using TSH blood tests to reach a normal range and relieve symptoms safely.AAFP+1

3. Synthroid (brand levothyroxine)
   Synthroid is a branded form of levothyroxine sodium approved for hypothyroidism in adults and children. It offers multiple tablet strengths to make fine dose adjustments. Doctors choose a starting dose and then slowly adjust based on blood tests and how the patient feels, watching for signs of too much thyroid hormone such as palpitations, weight loss, or tremor.FDA Access Data+1

4. Tirosint (levothyroxine soft-gel capsules)
   Tirosint is a soft-gel capsule form of levothyroxine that contains fewer inactive ingredients. It is useful for patients with absorption problems or allergies to tablet fillers. It is taken once daily on an empty stomach, usually 30–60 minutes before breakfast, and the dose is monitored and adjusted by TSH, just like other levothyroxine products.FDA Access Data+1

5. Ermeza or Tirosint-SOL (levothyroxine oral solution)
   Levothyroxine oral solutions are liquid forms used when swallowing tablets or capsules is hard, such as in children or patients with swallowing problems. They provide the same hormone as tablets but in a liquid that is easier to swallow and absorb. As with all levothyroxine, doses are individualized and taken on an empty stomach to improve absorption.FDA Access Data+1

6. Liothyronine sodium tablets (Cytomel and generics)
   Liothyronine is synthetic T3 hormone. It is sometimes combined with levothyroxine in selected patients or used in special situations like myxedema coma under expert care. Because T3 acts faster and is more potent, doses are lower and must be carefully monitored to avoid heart rhythm problems, chest pain, or symptoms of too much thyroid hormone.FDA Access Data+1

7. Combination T4/T3 therapy
   In a few patients with persistent symptoms on T4 alone, doctors may trial a combination of levothyroxine (T4) plus liothyronine (T3). This approach is controversial and must be supervised by an endocrinologist, using low T3 doses and careful monitoring of TSH, T3, and symptoms to reduce risk of heart and bone complications.AAFP+1

8. Desiccated thyroid extract (porcine thyroid)
   Desiccated thyroid (Armour Thyroid and similar) is made from dried pig thyroid glands and contains both T4 and T3. The FDA has recently emphasized that many animal-derived thyroid products are marketed without full approval, so their quality and consistency may vary. Because of this, guidelines usually prefer synthetic levothyroxine over desiccated thyroid, especially in severe disease.U.S. Food and Drug Administration+2U.S. Food and Drug Administration+2

9. Hydrocortisone (IV stress-dose glucocorticoid)
   In myxedema coma, doctors often give IV hydrocortisone before or with thyroid hormone until adrenal insufficiency is ruled out. This protects the body if the adrenal glands are weak and helps stabilize blood pressure and stress response. The dose is higher than usual replacement and is tapered once tests show normal adrenal function.journalmc.org+2Norfolk and Norwich University Hospitals+2

10. Other glucocorticoids (e.g., dexamethasone)
    Sometimes dexamethasone or other glucocorticoids are used instead of hydrocortisone, especially when adrenal testing is needed, because they do not interfere as much with some hormone tests. They provide strong anti-inflammatory and stress support while thyroid hormone is started, but are used short-term to limit long-term steroid side effects.journalmc.org+1

11. Broad-spectrum antibiotics
    In many myxedema coma cases, infection is the trigger. Doctors may start broad-spectrum antibiotics early, even before culture results, to treat possible pneumonia, urinary infection, or sepsis. Rapid infection control reduces stress on the body and improves the chance of survival, but antibiotic choices are always based on local guidelines and culture results.NCBI+1

12. Vasopressors (e.g., norepinephrine)
    If blood pressure remains dangerously low despite fluids and thyroid hormone, vasopressor drugs like norepinephrine may be given through a central line in the ICU. These drugs tighten blood vessels and raise blood pressure to protect the brain and kidneys, but they are used only under close monitoring because they can stress the heart.Norfolk and Norwich University Hospitals+1

13. Diuretics for fluid overload
    Some patients with severe hypothyroidism develop heart failure or fluid around the lungs and heart. In selected cases, mild diuretics may be used to remove extra fluid while thyroid hormone is corrected. Doses must be tailored carefully to avoid causing low blood pressure or kidney injury.NCBI+1

14. Anticoagulants (blood thinners)
    Critically ill patients are at increased risk of blood clots due to immobility. Low-dose anticoagulants may be used in hospital to prevent deep vein thrombosis or pulmonary embolism. The decision depends on bleeding risk and other conditions and is always made by the treating doctor.turkarchpediatr.org+1

15. Proton pump inhibitors (for gut protection)
    Stress ulcers can occur in very ill patients. Proton pump inhibitors may be given to protect the stomach, especially when the patient receives steroids or anticoagulants. This preventive therapy helps reduce bleeding risk while the main myxedema treatment continues.turkarchpediatr.org+1

16. Insulin and glucose management
    Severe illness can disturb blood sugar levels. Some patients need IV glucose if they are hypoglycemic, while others need insulin if stress or steroid use raises blood sugar. Careful blood sugar control helps protect the brain and reduces infection risk, but must be adjusted individually.turkarchpediatr.org+1

17. Pain medicines chosen carefully
    When pain relief is needed, doctors prefer non-sedating options and the lowest effective dose. Strong opioids and sedatives are used with extreme caution because they can further slow breathing and mental status in myxedema. This careful choice and dosing help keep the patient comfortable but safe.NCBI+1

18. Anti-arrhythmic drugs
    If serious heart rhythm problems develop, doctors may use anti-arrhythmic medicines under strict monitoring. However, because many arrhythmias improve as thyroid hormone is corrected, these drugs are used cautiously and often only in life-threatening situations.AAFP+1

19. Lipid-lowering drugs (e.g., statins)
    Chronic hypothyroidism increases cholesterol and long-term heart risk. After the acute phase, some patients benefit from statins or other lipid-lowering medicines to reduce cardiovascular risk. Thyroid function is usually corrected first, then lipids are re-checked before starting long-term cholesterol treatment.AAFP+1

20. Medicines for coexisting autoimmune conditions
    Myxedema can occur with autoimmune diseases like type 1 diabetes or rheumatoid arthritis. In such cases, patients may need insulin, immunosuppressants, or biologic drugs to control the other disease. Managing these conditions properly reduces stress on the body and helps stabilize thyroid control.AAFP+1

(Important: Dosages and exact timing are always individualized by doctors using official product labels, such as those on accessdata.fda.gov, and clinical guidelines; this information is educational only and not a dosing guide.)

Dietary molecular supplements

Dietary supplements cannot replace thyroid hormone medicines, but they may support general health when used under medical guidance. Over-supplementation, especially with iodine, can harm the thyroid, so always talk with a doctor first.AAFP+1

1. Iodine (only if deficient)
   Iodine is a key building block for thyroid hormones. In areas with low iodine intake, iodized salt or supplements can correct deficiency and help prevent hypothyroidism. However, too much iodine can worsen some thyroid diseases, so doses must be carefully guided by a doctor and usually come from diet rather than high-dose pills.AAFP+1

2. Selenium
   Selenium is needed for enzymes that convert T4 to T3 and protect the thyroid from oxidative stress. In some autoimmune thyroid conditions, selenium supplementation in moderate doses may slightly improve antibody levels, but it is not a stand-alone treatment. Excess selenium can be toxic, so any supplement should follow medical advice.AAFP+1

3. Zinc
   Zinc plays a role in hormone production and immune function. Low zinc can worsen fatigue and hair loss, which are also symptoms of hypothyroidism. A balanced multi-vitamin or diet rich in nuts, seeds, and lean meats usually provides enough zinc; high-dose supplements are rarely needed and should be supervised.AAFP+1

4. Iron
   Iron deficiency can worsen fatigue and may interfere with thyroid hormone metabolism. If blood tests show low iron or anemia, iron supplements can help, but they must be taken several hours apart from levothyroxine because they reduce its absorption. Doctors guide dose and duration based on ferritin and hemoglobin levels.AAFP+1

5. Vitamin D
   Vitamin D supports immune health, mood, and bone strength. Many people with chronic illnesses, including thyroid disease, have low vitamin D. Moderate vitamin D supplementation, based on blood levels, can support overall health but does not directly replace thyroid hormone.AAFP+1

6. Vitamin B12
   Some autoimmune thyroid patients have low B12, especially with pernicious anemia. B12 is important for nerve function and energy. If tests show low B12, injections or high-dose oral supplements may improve fatigue and nerve symptoms but must be guided by a clinician to avoid missing other causes of deficiency.AAFP+1

7. Omega-3 fatty acids
   Omega-3 fatty acids from fish oil or flaxseed have anti-inflammatory effects and support heart and brain health. They do not fix thyroid hormone levels but can support cardiovascular health in patients with long-standing hypothyroidism and high cholesterol, as part of a heart-healthy plan.AAFP+1

8. Probiotics
   Gut health may affect how well medicines and nutrients are absorbed. Probiotics from fermented foods or supplements can support a healthy gut microbiome. They do not treat myxedema directly but may help reduce digestive discomfort and support overall well-being in some people.AAFP+1

9. L-tyrosine (with caution)
   Tyrosine is an amino acid needed to build thyroid hormone. However, in someone already taking levothyroxine, extra tyrosine usually offers little benefit and may interact with other medicines. Because safety data are limited, tyrosine supplements should only be considered with professional advice, not as self-treatment.AAFP+1

10. General multivitamin
    A basic multivitamin that provides recommended daily amounts of essential vitamins and minerals can support nutrition in people with poor appetite or restrictive diets. It should not contain mega-doses of iodine or selenium. Even multivitamins should be taken several hours away from levothyroxine to avoid absorption problems.AAFP+1

Immune-supportive and regenerative / stem-cell–related drugs

At present, there are no stem cell drugs specifically approved for myxedema. Research is ongoing, and any “regenerative” approaches remain experimental and are not standard treatment. Standard care focuses on thyroid hormone replacement and managing complications.AAFP+1

1. Short-term glucocorticoids for stress support
   As mentioned, hydrocortisone or similar steroids are often given in myxedema coma to support the stress response and cover possible adrenal insufficiency. This helps immune and stress systems handle the severe illness but is not a long-term immune booster, since long steroid use can weaken immunity.journalmc.org+1

2. Vaccines (indirect immune support)
   Keeping up-to-date with vaccines (like flu and pneumonia vaccines) is an important way to support immunity in people with chronic illnesses. Preventing infections can reduce the risk of triggers that might worsen hypothyroidism or cause decompensation, especially in older or frail patients.AAFP+1

3. Biologic drugs for associated autoimmune diseases
   Some patients with autoimmune thyroiditis also have other autoimmune conditions treated with biologic drugs. These medicines are not for myxedema itself but can help control the underlying immune system imbalance that affects multiple organs. Because they change immune function, they are used very carefully by specialists.AAFP+1

4. Experimental stem cell research
   Researchers are exploring ways to grow thyroid cells from stem cells and possibly transplant them in the future. This may one day offer a more natural hormone source for some patients, but it is still in early research stages and not available as routine treatment. For now, levothyroxine remains the safe, proven therapy.Società Italiana di Endocrinologia

5. Erythropoiesis-stimulating agents (for severe anemia)
   If myxedema is accompanied by severe anemia, doctors may sometimes use drugs that stimulate red blood cell production. This is not a primary myxedema treatment but can support oxygen delivery and energy in selected patients with proven indications, such as chronic kidney disease.AAFP+1

6. Regenerative rehabilitation approaches
   “Regenerative” care for myxedema is mostly non-pharmacological: progressive exercise therapy, good nutrition, and control of other diseases. These approaches help muscles, nerves, and the cardiovascular system recover function over time after hormone levels are corrected. No specific regenerative drug is yet approved just for myxedema recovery.AAFP+1

Surgical and procedural treatments related to myxedema

Surgery does not treat myxedema directly, because the main problem is lack of thyroid hormone. However, some procedures may be needed to manage complications or underlying thyroid disease.AAFP+1

1. Thyroidectomy (partial or total thyroid removal)
   Some people develop severe hypothyroidism after thyroid surgery for nodules, goiter, or thyroid cancer. The surgery is done for those conditions, not for myxedema, but it creates the need for lifelong levothyroxine. In this context, surgery is the cause of hypothyroidism and myxedema risk, so careful hormone replacement afterward is vital.AAFP+1

2. Radioactive iodine ablation
   Radioactive iodine is used to treat hyperthyroidism or thyroid cancer. It destroys thyroid tissue and can later cause hypothyroidism if hormone replacement is not properly managed. The procedure is done for overactive or cancerous thyroid, but long-term follow-up and levothyroxine prevent myxedema from developing.AAFP+1

3. Pericardiocentesis
   Severe hypothyroidism can rarely cause fluid accumulation around the heart (pericardial effusion). If this fluid compresses the heart and causes tamponade, a needle procedure called pericardiocentesis is done to drain it. This procedure relieves pressure on the heart while thyroid hormone therapy treats the underlying cause.NCBI+1

4. Thoracentesis
   Fluid can also build up around the lungs (pleural effusion). When breathing becomes very difficult, a procedure called thoracentesis removes fluid with a needle. This improves breathlessness and oxygen levels while the main myxedema treatment continues.NCBI+1

5. Tracheostomy or airway procedures
   In rare cases with severe swelling or respiratory failure, airway procedures such as intubation or tracheostomy may be needed to secure breathing. These are emergency, life-saving procedures and are done in intensive care units while aggressive medical treatment for myxedema coma is given.NCBI+1

Prevention of myxedema

Preventing myxedema is much easier and safer than treating it after it appears. Simple, consistent habits greatly reduce risk.AAFP+1

1. Take thyroid hormone exactly as prescribed every day.

2. Do not stop levothyroxine suddenly without talking to your doctor.

3. Attend regular follow-up visits and blood tests (TSH, free T4).

4. Inform your doctor if you start new medicines that may affect absorption.AAFP+1

5. Use iodized salt in areas where iodine intake is low, unless your doctor advises otherwise.

6. Treat infections early and follow treatment fully.NCBI+1

7. Manage other illnesses (heart disease, diabetes) carefully with your healthcare team.

8. Avoid self-medicating with high-dose iodine or thyroid-related supplements.AAFP+1

9. Tell surgeons and anesthetists you have hypothyroidism before any operation.Norfolk and Norwich University Hospitals+1

10. Seek medical help quickly if you feel much more tired, cold, confused, or sleepy than usual.NCBI+1

When to see a doctor

You should see a doctor if you have ongoing symptoms like tiredness, feeling very cold, weight gain, constipation, dry skin, or hair loss, especially if you already know you have thyroid problems. A doctor can check your TSH and free T4 and adjust your thyroid medicine.AAFP+1

You need urgent or emergency medical care if you or someone else with hypothyroidism becomes very sleepy, confused, has trouble breathing, very low body temperature, swelling, low blood pressure, or seizures. These can be signs of myxedema coma, which is a medical emergency that needs immediate hospital treatment and intensive care.NCBI+1

Diet: what to eat and what to avoid

A balanced diet supports general health in people with hypothyroidism and myxedema, but it does not replace thyroid hormone pills.AAFP+1

Helpful foods to eat

1. Foods rich in iodine in moderation (iodized salt, some fish, dairy) if you are not on iodine restriction.

2. Lean proteins (fish, poultry, beans) to support muscles and energy.

3. Whole grains and fruits for fiber to help with constipation.

4. Healthy fats (olive oil, nuts, seeds) for heart health.

5. Foods rich in selenium and zinc, such as Brazil nuts and seafood, in small amounts.AAFP+1

Foods and habits to be careful with

1. Very high amounts of soy foods close to your levothyroxine dose, because soy can reduce absorption.

2. Large amounts of uncooked cruciferous vegetables (like raw cabbage, kale, broccoli) if iodine intake is low. Cooking reduces their goitrogenic effect.

3. High-fiber meals taken at the same time as your thyroid pill, because fiber may reduce absorption; take the pill on an empty stomach.AAFP+1

4. Iron, calcium supplements, or antacids within 4 hours of levothyroxine, because they bind the medicine.FDA Access Data+1

5. High-dose iodine or “thyroid support” supplements without medical advice.AAFP+1

Frequently asked questions (FAQs)

1. Is myxedema the same as hypothyroidism?
   Myxedema means very severe, long-standing hypothyroidism, often with thickened skin and swelling and sometimes with coma. All myxedema is hypothyroidism, but not all hypothyroidism is myxedema. Early diagnosis and treatment of hypothyroidism usually prevent myxedema.NCBI+1

2. Can myxedema be cured?
   The life-threatening state of myxedema coma can be reversed with fast hospital treatment, but most causes of hypothyroidism are permanent. People usually need thyroid hormone tablets for life to keep hormone levels normal and prevent the severe state from returning.NCBI+1

3. How long does it take to feel better after starting treatment?
   Some symptoms, like feeling cold and constipated, may improve within weeks, but full recovery of energy and skin or hair changes can take months. In myxedema coma, survival and early improvements depend on how quickly treatment is started and how sick the person is at the beginning.NCBI+1

4. Can I treat myxedema with diet or herbs only?
   No. Severe hypothyroidism and myxedema need prescription thyroid hormone. Diet, supplements, or herbs cannot replace levothyroxine or liothyronine. They can only support general health under medical supervision.AAFP+1

5. Is levothyroxine safe?
   Levothyroxine has been used for many years and is considered safe when doses are chosen and monitored by a doctor. Too little keeps you hypothyroid; too much can cause palpitations, weight loss, and bone loss. Regular blood tests keep the dose in the right range.FDA Access Data+1

6. Can I change between different brands of levothyroxine?
   Different brands and generics may have small differences in absorption. Many guidelines suggest staying on the same brand when possible and re-checking TSH if the brand changes so the dose can be adjusted if needed. Always tell your doctor if your pill looks different.AAFP+1

7. Do I need both T4 and T3 medicine?
   Most people do very well on T4 (levothyroxine) alone because the body converts T4 to T3. Only a minority of patients are considered for T4/T3 combination therapy, and this is done by specialists using low doses and close monitoring.AAFP+1

8. Can I get pregnant if I have hypothyroidism or a history of myxedema?
   Many people with well-controlled hypothyroidism can have healthy pregnancies. However, thyroid hormone needs usually increase during pregnancy, so doses and labs must be checked often. Poorly controlled hypothyroidism in pregnancy can harm the baby, so pre-pregnancy planning with your doctor is important.AAFP+1

9. Why do I still feel tired even when my TSH is normal?
   Fatigue can have many causes, such as anemia, sleep problems, depression, or other diseases. If thyroid labs are normal but symptoms continue, your doctor will look for other causes instead of just increasing levothyroxine, which could do more harm than good.AAFP+1

10. Can myxedema coma happen suddenly?
    Myxedema coma usually develops in someone with long-standing, uncontrolled hypothyroidism and a trigger such as infection, cold exposure, trauma, or stopping thyroid medicine. It may appear “suddenly” but usually follows weeks or months of worsening symptoms.NCBI+1

11. Will my hair grow back after treatment?
    Hair loss from hypothyroidism often improves after thyroid levels are corrected, but it may take several months for noticeable change. Other causes of hair loss, like iron deficiency or genetic baldness, can also play a role, so your doctor may check for these too.AAFP+1

12. Do children get myxedema?
    Severe hypothyroidism can occur in children, but newborn screening and earlier diagnosis make myxedema rare in developed health systems. When it does occur, prompt pediatric endocrine care is essential to protect growth and brain development.turkarchpediatr.org+1

13. Can I exercise if I have hypothyroidism or a past myxedema episode?
    Most people can and should exercise, but intensity should be increased slowly, especially if heart disease is present. In the acute myxedema phase, exercise is not safe; once stable and cleared by a doctor, gentle activity helps restore strength and energy.AAFP+1

14. Will I always need regular blood tests?
    Yes. Thyroid needs can change with age, weight change, pregnancy, new medicines, or illness. Regular TSH (and sometimes free T4) testing helps keep your dose correct and prevents both under-treatment and over-treatment.AAFP+1

15. What is the most important thing I can do to avoid myxedema?
    The single most important step is to take your prescribed thyroid hormone every day as directed and keep your follow-up appointments. Never stop your medicine on your own, and always seek care early if symptoms suddenly get much worse.AAFP+1

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December o2 , 2025.