Supraglottic Myxedema: Two Cases and a Review of the Literature

Abstract

Objective: We report two patients who presented with clinical symptoms of acute upper airway obstruction from presumed supraglottic myxedema and compare their clinical presentation, diagnosis, and management with previously reported cases. Methods: Clinical data, laboratory results, imaging and procedure reports were reviewed for both cases. A literature search was performed in MEDLINE using the terms "supraglottic myxedema", "myxedema", and "laryngeal edema". Relevant references were selected and reviewed. A 63-year-old man presented with confusion and facial and neck edema. The patient was subsequently intubated for airway protection. During intubation the epiglottis couldn't be visualized due to airway edema. Thyroid function testing revealed elevated thyroid stimulating hormone (TSH) and low free thyroxine (FT4). CT scan of the neck without contrast noted nonspecific mild, diffuse edema within the subcutaneous soft tissues. A 70-year-old man with a history of papillary thyroid cancer treated with total thyroidectomy and radioactive iodine presented with sore throat, stridor, lower eyelid edema and proptosis. Fiberoptic intranasal scope noted supraglottic edema. CT scan of the neck without contrast

Supraglottic Myxedema Presenting as a Complication of Hypothyroidism: A Case Report

“…Considering the easy availability of oral levothyroxine, a high dose was administered orally. In a literature review by Iftikhar et al [ 9 ], all patients treated for laryngeal myxedema, regardless of the route of levothyroxine administration, had successful outcomes in terms of mortality and discontinuation of mechanical ventilation.…”

“…All reported cases of laryngeal myxedema underwent tracheostomies post-intubation due to reasons such as self-extubation, prolonged intubation, and post-extubation stridor [6][7][8][9][10][11]. Planning early tracheostomies is essential in laryngeal myxedema as all patients will ultimately require it for a variable period.…”