Toxic multinodular goiter physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(27 intermediate revisions by 5 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Toxic multinodular goiter}}
{{Toxic multinodular goiter}}
{{CMG}}
{{CMG}}; {{AE}}{{Ajay}}
 
==Overview==
==Overview==
The clinical features of toxic multinodular goiter includes [[flushing]], [[diaphoresis]], smooth skin, [[onycholysis]], [[hyperpigmentation]], thinning of the hair, [[thyromegaly]],[[lymphadenopathy]], lid lag, [[Dyspnea on exertion|shortness of breath on exertion]], [[hypoxemia]], [[hypercapnia]], [[tachycardia]], [[atrial fibrillation]], [[weight loss]], [[increased appetite]], [[anorexia]], [[dysphagia]], [[increased urinary frequency]], [[enuresis]], [[gynecomastia]], [[reduced libido]], [[erectile dysfunction]], [[psychosis]], [[agitation]], and [[depression]], [[anxiety]], [[restlessness]], [[irritability]], and [[emotional lability]]. Some other features which may be seen are [[insomnia]], [[confusion]], poor orientation and immediate recall, [[amnesia]], and constructional difficulties, [[peripheral neuropathy]], [[carpal tunnel syndrome]], [[tremors]].
==Physical Examination==
==Physical Examination==
A physical examination will show one or many nodules in the thyroid. There may be a rapid heart rate.
===Appearance of the Patient===
 
Physical examination is as follows:<ref name="pmid3970328">{{cite journal |vauthors=Katlic MR, Grillo HC, Wang CA |title=Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital |journal=Am. J. Surg. |volume=149 |issue=2 |pages=283–7 |year=1985 |pmid=3970328 |doi= |url=}}</ref><ref name="pmid3885887">{{cite journal |vauthors=Katlic MR, Wang CA, Grillo HC |title=Substernal goiter |journal=Ann. Thorac. Surg. |volume=39 |issue=4 |pages=391–9 |year=1985 |pmid=3885887 |doi= |url=}}</ref><ref name="pmid6648812">{{cite journal |vauthors=Allo MD, Thompson NW |title=Rationale for the operative management of substernal goiters |journal=Surgery |volume=94 |issue=6 |pages=969–77 |year=1983 |pmid=6648812 |doi= |url=}}</ref><ref name="pmid6648812">{{cite journal |vauthors=Allo MD, Thompson NW |title=Rationale for the operative management of substernal goiters |journal=Surgery |volume=94 |issue=6 |pages=969–77 |year=1983 |pmid=6648812 |doi= |url=}}</ref><ref name="pmid7661484">{{cite journal |vauthors=Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A, Ughè M, Mattioli F |title=Surgical management of substernal goiter: analysis of 237 patients |journal=Am Surg |volume=61 |issue=9 |pages=826–31 |year=1995 |pmid=7661484 |doi= |url=}}</ref><ref name="pmid6831895">{{cite journal |vauthors=Torres A, Arroyo J, Kastanos N, Estopá R, Rabaseda J, Agustí-Vidal A |title=Acute respiratory failure and tracheal obstruction in patients with intrathoracic goiter |journal=Crit. Care Med. |volume=11 |issue=4 |pages=265–6 |year=1983 |pmid=6831895 |doi= |url=}}</ref><ref name="pmid11074902">{{cite journal |vauthors=Marqusee E, Benson CB, Frates MC, Doubilet PM, Larsen PR, Cibas ES, Mandel SJ |title=Usefulness of ultrasonography in the management of nodular thyroid disease |journal=Ann. Intern. Med. |volume=133 |issue=9 |pages=696–700 |year=2000 |pmid=11074902 |doi= |url=}}</ref><ref name="pmid11444166">{{cite journal |vauthors=Hegedüs L |title=Thyroid ultrasound |journal=Endocrinol. Metab. Clin. North Am. |volume=30 |issue=2 |pages=339–60, viii–ix |year=2001 |pmid=11444166 |doi= |url=}}</ref><ref name="pmid6648812">{{cite journal |vauthors=Allo MD, Thompson NW |title=Rationale for the operative management of substernal goiters |journal=Surgery |volume=94 |issue=6 |pages=969–77 |year=1983 |pmid=6648812 |doi= |url=}}</ref><ref name="pmid7661484">{{cite journal |vauthors=Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A, Ughè M, Mattioli F |title=Surgical management of substernal goiter: analysis of 237 patients |journal=Am Surg |volume=61 |issue=9 |pages=826–31 |year=1995 |pmid=7661484 |doi= |url=}}</ref><ref name="pmid6831895">{{cite journal |vauthors=Torres A, Arroyo J, Kastanos N, Estopá R, Rabaseda J, Agustí-Vidal A |title=Acute respiratory failure and tracheal obstruction in patients with intrathoracic goiter |journal=Crit. Care Med. |volume=11 |issue=4 |pages=265–6 |year=1983 |pmid=6831895 |doi= |url=}}</ref><ref name="pmid22147633">{{cite journal |vauthors=Banks CA, Ayers CM, Hornig JD, Lentsch EJ, Day TA, Nguyen SA, Gillespie MB |title=Thyroid disease and compressive symptoms |journal=Laryngoscope |volume=122 |issue=1 |pages=13–6 |year=2012 |pmid=22147633 |doi=10.1002/lary.22366 |url=}}</ref>
 
*Patients with [[thyroid adenoma]] are usually well-appearing.
 
=== Skin ===
* [[Flushing]]
* [[Diaphoresis]]
* Smooth skin
* [[Onycholysis]] and nail softening
* [[Hyperpigmentation]]
* Thinning of the hair
 
=== Neck ===
* [[Thyromegaly]] with solitary, non-tender thyroid nodules.
* Soft, smooth, and mobile nodules.
* [[Lymphadenopathy]]
 
===HEENT===
*Lid lag occurs in all patients with [[hyperthyroidism]] due to sympathetic overactivity.  
 
===Lungs===
* [[Shortness of breath]] on exertion
* [[Hypoxemia]]
* [[Hypercapnia]]
* [[Tracheal compression]] from a large [[goiter]].
* [[Pulmonary hypertension]].
 
===Heart===
* [[Tachycardia]] with [[wide pulse pressure]].
* [[Systolic hypertension]]
* [[Congestive heart failure]]
* [[Dilated cardiomyopathy]]
* [[Atrial fibrillation]]
 
===Abdomen===
*[[Weight loss]]
*[[Increased appetite]]
*[[Anorexia]] in older hyperthyroid patients.
*[[Dysphagia]]
 
===Genitourinary===
*Increased urinary frequency and [[nocturia]]
*[[Enuresis]] is common in children.
*[[Gynecomastia]]
*[[Reduced libido]]
*[[Erectile dysfunction]].
 
===Neuromuscular===
*[[Psychosis]], [[agitation]], and [[depression]].
*[[Anxiety]], [[restlessness]], [[irritability]], and [[Emotional lability|emotional lability.]]
*[[Insomnia]]
*[[Cognitive impairment|Cognitive impairments]] such as [[confusion]], poor orientation and immediate recall, [[amnesia]], and constructional difficulties.
*[[Peripheral neuropathy]]
*[[Carpal tunnel syndrome]]
 
===Extremities===
* High and low frequency amplitude [[tremors]] which can involve the face and head as well as the extremities.
* [[Myopathy]] 
* Muscle [[weakness]] with or without [[atrophy]] and [[myalgias]].
* Proximal and distal [[weakness]].
* [[Deep tendon reflex|Deep tendon reflexes]] are usually normal or increased, 
* [[Paresthesias]], due to coexisting [[polyneuropathy]]
 
=== Bone ===
*Osteoporosis and an increased fracture
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Disease]]
[[Category:Endocrinology]]


{{WikiDoc Help Menu}}
{{WH}}
{{WikiDoc Sources}}
{{WS}}

Latest revision as of 15:06, 13 November 2017

Toxic multinodular goiter Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Toxic multinodular goiter from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Toxic multinodular goiter physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Toxic multinodular goiter physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Toxic multinodular goiter physical examination

CDC on Toxic multinodular goiter physical examination

Toxic multinodular goiter physical examination in the news

Blogs on Toxic multinodular goiter physical examination

Directions to Hospitals Treating Toxic multinodular goiter

Risk calculators and risk factors for Toxic multinodular goiter physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ajay Gade MD[2]]

Overview

The clinical features of toxic multinodular goiter includes flushing, diaphoresis, smooth skin, onycholysis, hyperpigmentation, thinning of the hair, thyromegaly,lymphadenopathy, lid lag, shortness of breath on exertion, hypoxemia, hypercapnia, tachycardia, atrial fibrillation, weight loss, increased appetite, anorexia, dysphagia, increased urinary frequency, enuresis, gynecomastia, reduced libido, erectile dysfunction, psychosis, agitation, and depression, anxiety, restlessness, irritability, and emotional lability. Some other features which may be seen are insomnia, confusion, poor orientation and immediate recall, amnesia, and constructional difficulties, peripheral neuropathy, carpal tunnel syndrome, tremors.

Physical Examination

Appearance of the Patient

Physical examination is as follows:[1][2][3][3][4][5][6][7][3][4][5][8]

Skin

Neck

HEENT

  • Lid lag occurs in all patients with hyperthyroidism due to sympathetic overactivity.

Lungs

Heart

Abdomen

Genitourinary

Neuromuscular

Extremities

Bone

  • Osteoporosis and an increased fracture

References

  1. ↑ Katlic MR, Grillo HC, Wang CA (1985). "Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital". Am. J. Surg. 149 (2): 283–7. PMID 3970328.
  2. ↑ Katlic MR, Wang CA, Grillo HC (1985). "Substernal goiter". Ann. Thorac. Surg. 39 (4): 391–9. PMID 3885887.
  3. ↑ 3.0 3.1 3.2 Allo MD, Thompson NW (1983). "Rationale for the operative management of substernal goiters". Surgery. 94 (6): 969–77. PMID 6648812.
  4. ↑ 4.0 4.1 Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A, Ughè M, Mattioli F (1995). "Surgical management of substernal goiter: analysis of 237 patients". Am Surg. 61 (9): 826–31. PMID 7661484.
  5. ↑ 5.0 5.1 Torres A, Arroyo J, Kastanos N, Estopá R, Rabaseda J, Agustí-Vidal A (1983). "Acute respiratory failure and tracheal obstruction in patients with intrathoracic goiter". Crit. Care Med. 11 (4): 265–6. PMID 6831895.
  6. ↑ Marqusee E, Benson CB, Frates MC, Doubilet PM, Larsen PR, Cibas ES, Mandel SJ (2000). "Usefulness of ultrasonography in the management of nodular thyroid disease". Ann. Intern. Med. 133 (9): 696–700. PMID 11074902.
  7. ↑ Hegedüs L (2001). "Thyroid ultrasound". Endocrinol. Metab. Clin. North Am. 30 (2): 339–60, viii–ix. PMID 11444166.
  8. ↑ Banks CA, Ayers CM, Hornig JD, Lentsch EJ, Day TA, Nguyen SA, Gillespie MB (2012). "Thyroid disease and compressive symptoms". Laryngoscope. 122 (1): 13–6. doi:10.1002/lary.22366. PMID 22147633.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Toxic_multinodular_goiter_physical_examination&oldid=1387789"