8. Fluid Retention – The Swelling Dilemma
Edema, or fluid retention, is a symptom that can’t be ignored in patients with Myxedema Coma. The lack of thyroid hormones leads to an accumulation of mucopolysaccharides in the interstitial spaces, pulling fluid into the tissues and causing swelling. This isn’t the transient puffiness often shrugged off after a salty meal; it’s persistent and can be debilitating.
The swelling is most noticeable in the face, particularly around the eyes, and in the lower extremities. Patients may find that their shoes no longer fit, or that rings they once wore with ease are now uncomfortably tight. This swelling can also affect internal organs, contributing to ascites and pleural effusion—fluid accumulation in the abdominal cavity and around the lungs, respectively.
Fluid retention must be carefully managed to avoid exacerbating respiratory and cardiac issues. Diuretics are often used with caution, as they can lead to electrolyte imbalances and worsen hypotension. The primary focus remains on restoring thyroid function to correct the metabolic imbalance causing the edema. (8)
