Thyroid History Flashcards
Describe what would happen in hyperthyroidism to change in body weight
Decrease despite increased appetite (although 10% will gain weight)
Describe what would happen hypothyroidism to change in body weight
Increase
Describe what would happen in hyperthyroidism to change in appetite
Increase
Describe what would happen in hypothyroidism to change in appetite
Decrease
Describe what would happen in hyperthyroidism to change in voice
No change
Describe what would happen in hypothyroidism to change in voice
Hoarseness
Describe what would happen in hyperthyroidism to change in energy level
Can increase or decrease
Muscle weakness
Describe what would happen in hypothyroidism to change in energy level
Decrease
Somnolent
Slower movements and muscle weakness
Define somnolent
Tired and ready to fall asleep
Describe what hyperthyroidism to change in mood
Anxious
Irritable
Emotionally liable
Describe what hypothyroidism to change in mood
Lethargy
Depression
What would happen in hyperthyroidism to change in concentration
Decrease
What would happen in hypothyroidism to change in concentration
Decrease
What would happen in hyperthyroidism to change in heat tolerance
Sensitive to heat
Prefers a cool environment, wears fewer clothes
What would happen in hypothyroidism to change in heat tolerance
Sensitive to cold
Prefers a warm environment, wears extra clothes
What would happen in hyperthyroidism to change in skin, nails and hair
Increased sweating
Fine hair and hair loss
Clubbing (thyroid acropachy)
Onycholysis (separation of the nail from the nailbed)
What would happen in hypothyroidism to change in skin, nails and hair
Dry flaky skin
Coarse thinning hair
Brittle nails
What would happen in hyperthyroidism to change in heart rate/rhythm
Tachycardia
Palpitations
Atrial fibrillation
What would happen in hypothyroidism to change in heart rate/rhythm
Bradycardia
What would happen to change in menstrual cycle in hyperthyroidism
Infrequent menses
Fertility problems
What would happen in change in menstrual cycle in hypothyroidism
Heavy, prolonged or irregular menses
fertility problems and increased risk of miscarriage
Define menses
Menstruation
What are 3 specific areas to cover in a thyroid history
Drug history and allergies
Social history
Family history
Why is drug history important in thyroid history
Specifically enquire about thyroxine, lithium, amiodarone and glucocorticoids
Why is social history important in thyroid history
Smoking, alcohol, diet (sufficient iodine), and effect of activities of daily living
Name 5 examples of glucocorticoids
Beclomethasone
Dexamethasone
Hydrocortisone
Prednisolone
Methylprednisolone
Why is family history important in a thyroid history
Thyroid disease can be familial
Describe the role of T3 if it is high
Increases metabolism = weight decreases + potentiates effects of catecholamines e.g. adrenaline resulting in excessive sympathetic output (tremor, tachycardia, anxiety)
Describe the role of T3 if it is low
Results in weight gain, low mood, constipation, poor memory, hyporeflexia
What are you looking for when checking general appearance in a thyroid examination
Build
Inappropriate clothing
Restlessness
Confusion
Quality of skin and hair
Describe thyroid acropachy
Similar appearance to finger clubbing - caused by periosteal phalangeal bone overgrowth secondary to Grave’s disease
Describe onycholysis
Painless detachment of the nail from the nail bed associated with hyperthyroidism
What is thyroid acropachy associated with
Secondary to graves disease
(similar appearance to finger clubbing but caused by periosteal phalangeal bone overgrowth)
In thyroid condition when would onycholysis be seen
Hyperthyroidism
In which thyroid condition would palmar erythema be seen
Hyperthyroidism
Describe palmar erythema
Reddening of the palms associated with hyperthyroidism, chronic liver disease and pregnancy
What hand signs are you looking for
Palmar erythema
Clubbing (thyroid acropachy)
Brittle nails
Onycholysis
In peripheral tremor what is it a feature of
Hyperthyroidism
Reflecting the sympathetic nervous system overactivity
How long much an irregular rhythm be calculated for
60 seconds
What is a healthy adult pulse
60-100 bpm
What is bradycardia and its causes
<60bpm
Healthy athletic individuals, hypothyroidism, atrioventricular block, medications, sick sinus syndrome
What would be seen in a heart for hypothyroidism
< 60 bpm (bradycardia)
Describe tachycardia and its causes
> 100bpm
Hyperthyroidism, anxiety, supraventricular tachycardia, hypovolaemia
What thyroid condition is atrial fibrillation associated with
Atrial fibrillation
What is dry skin associated with
Hypothyroidism
What is excessive sweating associated with
Hyperthyroidism
What is the absence of the outer 3rd of the eyebrows associated with
Hypothyroidism (rare sign)
Describe exophthalmos
Proptosis (forward displacement of the eye)
Grave’s disease
What bilateral eye feature is seen in Graves disease
Exophthalmos
Why does exophthalmos occur
Bulging of the eye anteriorly out of the orbit
Due to oedema and lymphocytic infiltration of orbital fat, connective tissue and extraocular muscles
Describe lid retraction
Inspect eyes from the front and note if sclera is visible between upper lid margin and the corneal limbus
What thyroid condition is lid retraction seen in
All hyperthyroidism
Is most common ocular sign of Graves’ disease
Describe why lid retraction occurs
Occur due to the sympathetic hyperactivity causing excessive contraction of the superior tarsal and levator palpebrae superioris muscles
How do you inspect for lid lag
Ask patient to look down
Delayed downward movement of the eyelids on downgaze indicated lid lag sign
What is lid lag a sign of
Hyperthyroidism
What signs of inflammation are seen in thyroid disease
Due to lid retraction and exophthalmos, the eye is more prone to dryness and development of
conjunctival oedema (chemosis)
conjunctivitis
Corneal ulceration (severe cases)
Define lid lag
Refers to a delay in the descent of the upper eyelid in relation to the eyelid when looking down
If a lump in the neck moves when water is swallowed what does this suggest
Thyroid mass
Describe the movement of thyroid gland masses (e.g. goitre) and thyroglossal cysts with swallowing
Typically move upwards
Describe the movement of lymph nodes with swallowing
Typically move very little
Describe the movement of n invasive thyroid malignancy with swallowing
May not move with swallowing if tethered to surrounding tissue
Describe the movement of thyroglossal cysts when a patient protrude their toungue
Move upwards
Why do you percuss in a thyroid examination
Percuss upper sternum for retrosternal extension of the goitre
Why do you auscultate in a thyroid examination
For a bruit (each lobe) using bell of stethoscope
What do bruits of the thyroid suggest
Indicates increased vascularity (typically occurs in Graves disease)
What condition is thyroid bruits secondary to
Graves disease
Describe proximal myopathy
(proximal weakness)
Potential complication of multinodular goitre and Graves’ disease
Develop wasting of their proximal musculature causing difficulties in tasks e.g. standing from a sitting position
What conditions is proximal myopathy a potential complication of
Multinodular goitre and Graves disease
What is hyporeflexia associated with
Hypothyroidism
What is checking reflexes associated with
Hypothyroidism
Describe pretibial myxoedema
Form of diffuse mucinosis in which there is an accumulation of excess glycosaminoglycans in dermis and subcutis of the skin
How does pretibial myxoedema present
Waxy, discoloured induration of the skin on the anterior aspect of the lower legs (pre-tibial region)
What is pretibial myxoedema a rare complication
Graves’ disease
Give an example summary of a thyroid examination
“Today I examined Mr Smith, a 32-year-old male. On general inspection, the patient appeared hyperactive at rest, with a peripheral tremor. There were no objects or medical equipment around the bed of relevance.”
“The patient was tachycardic at 105 bpm with a regular pulse. Inspection of the neck was unremarkable but palpation revealed a mass in the thyroid region that contained multiple nodules. The mass moved upwards on swallowing but was stationary during tongue protrusion. There was no palpable lymphadenopathy but retrosternal dullness was present to the level of the manubrium. Auscultation of the thyroid gland did not reveal any bruits, reflexes were normal and there was no evidence of pretibial myxoedema or proximal myopathy.”
“In summary, these findings are consistent with a toxic multinodular goitre.”
“For completeness, I would like to perform the following further assessments and investigations.”
What further investigations can be done after a thyroid examination
Thyroid function tests - TSH, T3, T4
ECG (if irregular pulse)
Ultrasound scan of neck
