Thyroid

Question 1

What questions will you ask when taking a history from someone with suspected thyroid problems?

Answer 1

About changes in: Weight? Appetite? Bowel habit? Energy? Mood? Concentration? Heat tolerance?
Voice? Skin, hair and nails? Hear rate/rhythm? Menstrual cycle?

Question 2

What symptoms would you expect someone with hyperthyroidism to present with?

Answer 2

Decrease in body weight (though 10% gain weight)
Increase in appetite
Increased frequency of defecation or diarrhoea
Increased/decrease energy, muscle weakness
Anxious, irritable, emotionally unstable
Decrease in concentration
Prefers cool environment, wears fewer clothes
Increased sweating, fine hair and hair loss, clubbing (acropachy), onycholyisis
Tachyc/palpitations/AF
Infrequent menstrual cycle, fertility problems

Question 3

What symptoms would you expect someone with hypothyroidism to present with?

Answer 3

Increase in body weight
Decrease in appetite 
Constipation 
Decrease in energy, slower movement and muscle weakenss
Lethargy, depression 
Decrease in concentration 
Prefers warm environment, wears extra clothes 
Hoarsness of voice 
Dry flaky skin
Coarse thinning hair 
Brittle nails 
Bradycardia 
Heavy, prolonged or irregular menstrual cycle, fertility problems

Question 4

What you must also remember to ask about?

Answer 4

Onset and duration of symptoms
Any associated pain or discomfort
Previous thyroid disease, surgery or treatment

Question 5

DH & A thyroid presentation?

Answer 5

Thyroxine?
Lithium? (hypot. due to decreased T4/3 synthesis)
Amiodarone?
sulphonylureas?

Question 6

SH thyroid presentation?

Answer 6

Smoking? Alcohol? Diet? (sufficient iodine?) effects on daily living?

Question 7

FH?

Answer 7

Can be familial