Postpartum thyroiditis physical examination: Difference between revisions

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{{Postpartum thyroiditis}}
{{Postpartum thyroiditis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{SKA}}  


==Overview==
==Overview==
The presence of signs of hyperthyroidism or hypothyroidism in postpartum period on physical examination is highly suggestive of PPT.
The presence of signs of [[hyperthyroidism]] or [[hypothyroidism]] in postpartum period on physical examination is highly suggestive of [[Postpartum thyroiditis|PPT.]]
==Physical Examination==
==Physical Examination==
The presence of signs of hyperthyroidism or hypothyroidism in postpartum period  on physical examination is highly suggestive of PPT.
The presence of signs of [[hyperthyroidism]] or [[hypothyroidism]] in postpartum period  on physical examination is highly suggestive of PPT.
<ref name="pmid10874538">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }} </ref>
<ref name="pmid15157842">{{cite journal| author=Stagnaro-Green A| title=Postpartum thyroiditis. | journal=Best Pract Res Clin Endocrinol Metab | year= 2004 | volume= 18 | issue= 2 | pages= 303-16 | pmid=15157842 | doi=10.1016/j.beem.2004.03.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15157842  }} </ref>


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with PPT usually appear tired or irritable depend of the phase of disease.{| class="wikitable" ! ! ! ! |- | | | | |- | | | | |- | | | | |}
*Patients with PPT usually appear tired or irritable depend of the phase of disease.
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
===Vital Signs===
| valign="top" |
 
|+
*High-grade / low-grade fever
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Systems involved}}
*[[Hypothermia]] / hyperthermia may be present
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Hyperthyroidism}}
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Hypothyroidism}}
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
|-
*Tachypnea / bradypnea
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Vital Signs
*Kussmal respirations may be present in _____ (advanced disease state)
| style="padding: 5px 5px; background: #F5F5F5;" |
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
* Low-grade fever
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
* [[Tachycardia]] with regular pulse or irregular pulse
 
* [[Tachypnea]]
===Skin===
* High blood pressure
*[[Cyanosis]]  
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Jaundice]]
* [[Bradycardia]] with regular pulse
* Low blood pressure
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Skin
| style="padding: 5px 5px; background: #F5F5F5;" |
* Sweating increased
* [[Onycholysis]]
* Hyperpigmentation
* [[Pruritus]] and hives
* Vitiligo and [[alopecia areata]]
* Thinning of the hair
* Pretibial myxedema in co-existing [[Grave's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Sweating decreased
* Dry skin
* Hair coarse and brttile
* Brittle nails
* [[Nonpitting edema|Non-pitting edema]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |HEENT
| style="padding: 5px 5px; background: #F5F5F5;" |
* Stare and lid lag
* [[Proptosis]]
* Gritty sensation in eyes
* Lid lag
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Icteric sclera]]
* [[Pallor]]
* [[Pallor]]
* Bruises
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Abdomen
<gallery widths="150px">
| style="padding: 5px 5px; background: #F5F5F5;" |
 
* [[Abdominal distention]] in patients with [[constipation]]  
UploadedImage-01.jpg | Description {{dermref}}
*[[Abdominal tenderness]] in the right upper abdominal quadrant with autoimmune hepatitis
UploadedImage-02.jpg | Description {{dermref}}
*[[Hepatomegaly]] or [[splenomegaly]] or [[hepatosplenomegaly]]
 
*Dull note on [[percussion]] in [[peritoneal effusion]]
</gallery>
| style="padding: 5px 5px; background: #F5F5F5;" |
 
* Increased peristaltic movements in patients
===HEENT===
|-
* Abnormalities of the head/hair may include ___
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Back
* Evidence of trauma
| style="padding: 5px 5px; background: #F5F5F5;" |
* Icteric sclera
*Point tenderness over lumbar vertebrae in [[osteoporosis]]
* [[Nystagmus]]
*Costovertebral angle tenderness bilaterally [[osteoporosis]]
* Extra-ocular movements may be abnormal
| style="padding: 5px 5px; background: #F5F5F5;" |
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
* Point tenderness over lumbar vertebrae in [[osteoporosis]]
*Ophthalmoscopic exam may be abnormal with findings of ___
*Costovertebral angle tenderness bilaterally [[osteoporosis]]
* Hearing acuity may be reduced
|-
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
|                                          '''Genitourinary'''
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
|
* [[Exudate]] from the ear canal
* Urinary frequency
* Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
* Menstrual irregularities
*Inflamed nares / congested nares
|
* [[Purulent]] exudate from the nares
* Menstrual irregularities
* Facial tenderness
|-
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
|                           '''CNS'''
 
|
===Neck===
* [[Hyperreflexia]]
*[[Jugular venous distension]]
* Proximal muscle weakness
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
* Unilateral or bilateral [[tremor]]
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
* [[Anxiety]], [[restlessness]], irritability, and emotional liability
*[[Thyromegaly]] / thyroid nodules
|
*[[Hepatojugular reflux]]
* [[Hyporeflexia]]
 
* Proximal muscle weakness
===Lungs===
* low mood, [[depression]]
* Asymmetric chest expansion / Decreased chest expansion
* [[Carpal tunnel syndrome]]  
*Lungs are hypo/hyperresonant
|-
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
|                        '''Extremities'''
*Rhonchi
|
*Vesicular breath sounds / Distant breath sounds
* [[Fasciculations]]  
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
* [[Tremor|Tremors]] in the upper and lower extremity
*[[Wheezing]] may be present
|
*[[Egophony]] present/absent
* [[Clubbing]] in hypothyroid phase
*[[Bronchophony]] present/absent
* Non-pitting [[edema]] of the lower extremities in [[hypothyroid]] phase
*Normal/reduced [[tactile fremitus]]
* [[Muscle atrophy]]
 
|}
===Heart===
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
*[[Clubbing]]  
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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[[Category: (name of the system)]]
[[Category: Endocrinology]]

Latest revision as of 17:56, 10 November 2017

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

Overview

The presence of signs of hyperthyroidism or hypothyroidism in postpartum period on physical examination is highly suggestive of PPT.

Physical Examination

The presence of signs of hyperthyroidism or hypothyroidism in postpartum period on physical examination is highly suggestive of PPT. [1] [2]

Appearance of the Patient

  • Patients with PPT usually appear tired or irritable depend of the phase of disease.
Systems involved Hyperthyroidism Hypothyroidism
Vital Signs
Skin
HEENT
  • Stare and lid lag
  • Proptosis
  • Gritty sensation in eyes
  • Lid lag
Abdomen
  • Increased peristaltic movements in patients
Back
Genitourinary
  • Urinary frequency
  • Menstrual irregularities
  • Menstrual irregularities
CNS
Extremities

References

  1. ↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
  2. ↑ Stagnaro-Green A (2004). "Postpartum thyroiditis". Best Pract Res Clin Endocrinol Metab. 18 (2): 303–16. doi:10.1016/j.beem.2004.03.008. PMID 15157842.

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