What is the treatment for myxedema symptoms?

From the Guidelines

The primary treatment for myxedema symptoms is thyroid hormone replacement therapy, typically with levothyroxine (T4), with the goal of normalizing TSH levels and alleviating symptoms. According to the most recent guidelines, treatment usually begins with a low dose of levothyroxine, such as 25-50 mcg daily, which is gradually increased every 4-6 weeks based on symptoms and thyroid function tests until optimal levels are achieved 1. The maintenance dose typically ranges from 1.6-1.8 mcg/kg/day for most adults.

Key Considerations

• Elderly patients or those with heart disease may require lower starting doses (12.5-25 mcg daily) to avoid cardiac complications.
• Blood tests to measure TSH levels should be performed 6-8 weeks after starting treatment or changing doses, with the goal of normalizing TSH levels (usually 0.5-4.0 mIU/L) 1.
• Patients should take levothyroxine on an empty stomach, 30-60 minutes before breakfast, and avoid taking it with calcium supplements, iron, or certain medications that can interfere with absorption.
• Treatment is typically lifelong, and patients should not discontinue medication without medical supervision.
• In severe cases of myxedema coma, intravenous thyroid hormone replacement and supportive care in an intensive care setting are necessary, with consideration of hospital admission for developing myxedema (bradycardia, hypothermia, and altered mental status) 1.

Management of Toxicities

• For grade 1 toxicities, continue ICPi with close follow-up and monitoring of TSH, FT4 1.
• For grade 2 toxicities, may hold ICPi until symptoms resolve to baseline, and consider endocrinology consultation 1.
• For grade 3-4 toxicities, hold ICPi until symptoms resolve to baseline with appropriate supplementation, and consider endocrinology consultation and hospital admission for IV therapy if signs of myxedema are present 1.

From the FDA Drug Label

1. 3 Myxedema Coma

Myxedema coma is a life-threatening emergency characterized by poor circulation and hypometabolism and may result in unpredictable absorption of levothyroxine sodium from the gastrointestinal tract. Use of oral thyroid hormone drug products is not recommended to treat myxedema coma. Administer thyroid hormone products formulated for intravenous administration to treat myxedema coma.

The treatment for myxedema symptoms, specifically myxedema coma, is intravenous administration of thyroid hormone products, as oral thyroid hormone drug products are not recommended due to unpredictable absorption. 2

From the Research

Myxedema Symptoms and Treatment

• Myxedema coma is a life-threatening endocrine emergency with a high mortality rate resulting from severe insufficiency of thyroid hormones 3.
• The standard therapy for myxedema coma in many countries is intravenous levothyroxine replacement 3.
• However, some studies suggest that oral levothyroxine can be an effective treatment option, especially in resource-limited settings where intravenous thyroid hormone replacement is not available 4, 5.
• A combination therapy of levothyroxine and liothyronine has also been shown to be effective in treating myxedema coma 6.
• The treatment of myxedema coma typically involves intensive supportive care and thyroid hormone replacement therapy, with the goal of normalizing thyroid hormone levels and relieving symptoms 3, 6, 4, 5.

Treatment Options

• Intravenous levothyroxine replacement is considered the standard therapy for myxedema coma in many countries 3.
• Oral levothyroxine can be an effective treatment option, especially in resource-limited settings 4, 5.
• Combination therapy of levothyroxine and liothyronine has been shown to be effective in treating myxedema coma 6.
• The dosage of levothyroxine can vary depending on the patient's age, weight, and medical history, with typical starting doses ranging from 12.5 to 200 mcg per day 3, 6, 5, 7.

Important Considerations

• Early recognition and treatment of myxedema coma is essential to improve outcomes 3, 6, 4, 5.
• Patients with myxedema coma often require intensive supportive care, including management of hypotension, hypothermia, and hypoventilation 3, 6, 4, 5.
• The diagnosis of myxedema coma is based on clinical suspicion, especially in patients with hypothyroidism and in the presence of precipitating factors 5.