Thyroid History and Examination

Question 1

Presenting complaint of thyrotoxicosis

Answer 1

-Presenting complaint
=Ask patient to describe when it started and symptoms

-History of presenting complaint
=Open question to let patient tell you about what has happened
=Specific direct questions re other symptoms related to thyroid disease

Question 2

Symptoms of thyrotoxicosis

Answer 2

-Palpitations (risk of AF)
-Weight loss
-Heat intolerance
-Increased appetite
-Shortness of breath on exertion
-Lethargy
-Insomnia
-Hyperactivity during day
-Diarrhoea
-Oligomenorrhoea (light/infrequent)
-Exophthalmos
-Thyroid eye disease
-Proximal myopathy (difficulty raising arms/ getting out of chair)
-Goitre

Question 3

Full history list

Answer 3

-Past Medical History (autoimmune conditions, asthma for beta blockers)
-Family History (thyroid disease, autoimmune, genetic)
-Drug History (interactions), allergies
-Social History
=Who do they live with at home, occupation, smoking-worse, contraindication (radioiodine)
-Systemic enquiry
=CVS
=RS
=GI
=UG/Reproductive history (NB especially in women planning pregnancy)
=CNS

Question 4

Examination findings of thyrotoxicosis

Answer 4

-Observation – general inspection, can’t still still, weight loss, agitated, pressured speech, lighter clothing, peaches and cream complexion, hair loss in eyebrows
-Hands (palmar erythema (hyperdynamic circulation), sweatiness, onycholysis (nail changes), tachycardia, ? atrial fibrillation, tremor (fine)
-Neck – thyroid enlargement (swallow), size, nature, bruit, cervical lymphadenopathy, retrosternal extension
-Eyes – exophthalmos, lid-lag, proptosis (CAS score), range of eye movements
-Others (rare) – gynaecomastia, pre-tibial myxoedema, proximal myopathy (wasting of major muscles), hyper-reflexia

Question 5

Differentials to consider with abnormal TFTs

Answer 5

-sick euthyroid syndrome or over/under treatment with thyroxine