Toxic multinodular goiter physical examination: Difference between revisions
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===Lungs=== | ===Lungs=== | ||
* | * Shortness of breath on exertion | ||
* Hypoxemia | * Hypoxemia | ||
* Tracheal | * Hypercapnia | ||
* Pulmonary hypertension. | * Tracheal compression from a large goiter. | ||
* Pulmonary hypertension. | |||
===Heart=== | ===Heart=== | ||
Revision as of 18:32, 9 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Physical Examination
Appearance of the Patient
- Patients with thyroid adenoma are usually well-appearing.
- Tachycardia may be present.
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
- Heart rate is increased with wide pulse pressure.
- Systolic hypertension, congestive heart failure, and dilated cardiomyopathy can occur in patients with severe hyperthyroidism.
- Atrial fibrillation occurs in patients with hyperthyroidism
- In 60% of hyperthyroid patients with atrial fibrillation, the rhythm converts spontaneously to sinus rhythm when the hyperthyroidism is treated.
Abdomen
- Weight loss is due to increased metabolic rate
- Most patients have hyperphagia
- Anorexia may be prominent in older hyperthyroid patients.
- Dysphagia due to goiter
- Cholestiatosis
Genitourinary
- Urinary frequency and nocturia are common in hyperthyroidism.
- Enuresis is common in children.
- Serum sex hormone-binding globulin (SHBG) concentrations are high.
- Extragonadal conversion of testosterone to estradiol is increased, so that serum estradiol concentrations are high. These changes can cause gynecomastia, reduced libido, and erectile dysfunction.
- Spermatogenesis is often decreased or abnormal.
Neuromuscular
- psychosis, agitation, and depression.
- anxiety, restlessness, irritability, and emotional lability.
- Insomnia is also common.cognitive impairments confusion, poor orientation and immediate recall, amnesia, and constructional difficulties.
- Peripheral neuropathy A symmetric distal sensory disturbance and reduced Achilles reflexes are the most common features. Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy have also been described in patients with hyperthyroidism, probably reflecting an underlying predisposition to autoimmune disease.
- Carpal tunnel syndrome
Extremities
- Tremor is common in patients with thyrotoxicosis. The tremor is kinetic, high frequency and low amplitude and can involve the face and head as well as the extremities.
- Myopathy
- Muscle weakness with or without atrophy and myalgias occurs in 60 to 80 percent of patients with untreated hyperthyroidism. Acute thyrotoxic myopathy may present with more severe proximal and distal weakness. muscle atrophy is usually absent. However. Deep tendon reflexes are usually normal or increased, Paresthesias, due to coexisting polyneuropathy may be present.
Bone
- Bone resorption due to increased bone turn over
- The loss in cortical bone density is greater than that of trabecular bone.
- Osteoporosis and an increased fracture