Toxic multinodular goiter physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ajay Gade MD[2]]
Overview
The clinical features of toxic multinodular goiter includes flushing, diaphoresis, smooth skin, onycholysis, hyperpigmentation, thinning of the hair, thyromegaly,lymphadenopathy, lid lag, shortness of breath on exertion, hypoxemia, hypercapnia, tachycardia, atrial fibrillation, weight loss, increased appetite, anorexia, dysphagia, increased urinary frequency, enuresis, gynecomastia, reduced libido, erectile dysfunction, psychosis, agitation, and depression, anxiety, restlessness, irritability, and emotional lability. Some other features which may be seen are insomnia, confusion, poor orientation and immediate recall, amnesia, and constructional difficulties, peripheral neuropathy, carpal tunnel syndrome, tremors.
Physical Examination
Appearance of the Patient
Physical examination is as follows:[1][2][3][3][4][5][6][7][3][4][5][8]
- Patients with thyroid adenoma are usually well-appearing.
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
- Tachycardia with wide pulse pressure.
- Systolic hypertension
- Congestive heart failure
- Dilated cardiomyopathy
- Atrial fibrillation
Abdomen
- Weight loss
- Increased appetite
- Anorexia in older hyperthyroid patients.
- Dysphagia
Genitourinary
- Increased urinary frequency and nocturia
- Enuresis is common in children.
- Gynecomastia
- Reduced libido
- Erectile dysfunction.
Neuromuscular
- Psychosis, agitation, and depression.
- Anxiety, restlessness, irritability, and emotional lability.
- Insomnia
- Cognitive impairments such as confusion, poor orientation and immediate recall, amnesia, and constructional difficulties.
- Peripheral neuropathy
- Carpal tunnel syndrome
Extremities
- High and low frequency amplitude tremors which can involve the face and head as well as the extremities.
- Myopathy
- Muscle weakness with or without atrophy and myalgias.
- Proximal and distal weakness.
- Deep tendon reflexes are usually normal or increased,
- Paresthesias, due to coexisting polyneuropathy
Bone
- Osteoporosis and an increased fracture
References
- ↑ Katlic MR, Grillo HC, Wang CA (1985). "Substernal goiter. Analysis of 80 patients from Massachusetts General Hospital". Am. J. Surg. 149 (2): 283–7. PMID 3970328.
- ↑ Katlic MR, Wang CA, Grillo HC (1985). "Substernal goiter". Ann. Thorac. Surg. 39 (4): 391–9. PMID 3885887.
- ↑ 3.0 3.1 3.2 Allo MD, Thompson NW (1983). "Rationale for the operative management of substernal goiters". Surgery. 94 (6): 969–77. PMID 6648812.
- ↑ 4.0 4.1 Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A, Ughè M, Mattioli F (1995). "Surgical management of substernal goiter: analysis of 237 patients". Am Surg. 61 (9): 826–31. PMID 7661484.
- ↑ 5.0 5.1 Torres A, Arroyo J, Kastanos N, Estopá R, Rabaseda J, Agustí-Vidal A (1983). "Acute respiratory failure and tracheal obstruction in patients with intrathoracic goiter". Crit. Care Med. 11 (4): 265–6. PMID 6831895.
- ↑ Marqusee E, Benson CB, Frates MC, Doubilet PM, Larsen PR, Cibas ES, Mandel SJ (2000). "Usefulness of ultrasonography in the management of nodular thyroid disease". Ann. Intern. Med. 133 (9): 696–700. PMID 11074902.
- ↑ Hegedüs L (2001). "Thyroid ultrasound". Endocrinol. Metab. Clin. North Am. 30 (2): 339–60, viii–ix. PMID 11444166.
- ↑ Banks CA, Ayers CM, Hornig JD, Lentsch EJ, Day TA, Nguyen SA, Gillespie MB (2012). "Thyroid disease and compressive symptoms". Laryngoscope. 122 (1): 13–6. doi:10.1002/lary.22366. PMID 22147633.