Postpartum thyroiditis physical examination: Difference between revisions

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VisualWikitext

Latest revision as of 17:56, 10 November 2017

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	Low-grade fever Tachycardia with regular pulse or irregular pulse Tachypnea High blood pressure	Bradycardia with regular pulse Low blood pressure
Skin	Sweating increased Onycholysis Hyperpigmentation Pruritus and hives Vitiligo and alopecia areata Thinning of the hair Pretibial myxedema in co-existing Grave's disease	Sweating decreased Dry skin Hair coarse and brttile Brittle nails Non-pitting edema
HEENT	Stare and lid lag Proptosis Gritty sensation in eyes Lid lag	Icteric sclera Pallor
Abdomen	Abdominal distention in patients with constipation Abdominal tenderness in the right upper abdominal quadrant with autoimmune hepatitis Hepatomegaly or splenomegaly or hepatosplenomegaly Dull note on percussion in peritoneal effusion	Increased peristaltic movements in patients
Back	Point tenderness over lumbar vertebrae in osteoporosis Costovertebral angle tenderness bilaterally osteoporosis	Point tenderness over lumbar vertebrae in osteoporosis Costovertebral angle tenderness bilaterally osteoporosis
Genitourinary	Urinary frequency Menstrual irregularities	Menstrual irregularities
CNS	Hyperreflexia Proximal muscle weakness Unilateral or bilateral tremor Anxiety, restlessness, irritability, and emotional liability	Hyporeflexia Proximal muscle weakness low mood, depression Carpal tunnel syndrome
Extremities	Fasciculations Tremors in the upper and lower extremity	Clubbing in hypothyroid phase Non-pitting edema of the lower extremities in hypothyroid phase Muscle atrophy

References

↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
↑ 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.

Template:WH Template:WS

[pmid10874538-1] Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.

[pmid15157842-2] 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.

[1]

[2]

@@ Line 5: / Line 5: @@
 ==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==
-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===
@@ Line 18: / Line 20: @@
 ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Hypothyroidism}}
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Vital Signs
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+* Low-grade fever
+* [[Tachycardia]] with regular pulse or irregular pulse
+* [[Tachypnea]]
+* High blood pressure
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+* [[Bradycardia]] with regular pulse
+* Low blood pressure
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Skin
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+* 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;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+* 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;" |Differential 3
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |HEENT
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+* Stare and lid lag
+* [[Proptosis]]
+* Gritty sensation in eyes
+* Lid lag
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+* [[Icteric sclera]]
+* [[Pallor]]
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Abdomen
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+* [[Abdominal distention]] in patients with [[constipation]]
+*[[Abdominal tenderness]] in the right upper abdominal quadrant with autoimmune hepatitis
+*[[Hepatomegaly]] or [[splenomegaly]] or [[hepatosplenomegaly]]
+*Dull note on [[percussion]] in [[peritoneal effusion]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+* Increased peristaltic movements in patients
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Back
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
+*Point tenderness over lumbar vertebrae in [[osteoporosis]]
+*Costovertebral angle tenderness bilaterally [[osteoporosis]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
+* Point tenderness over lumbar vertebrae in [[osteoporosis]]
+*Costovertebral angle tenderness bilaterally [[osteoporosis]]
+|-
+|                                           '''Genitourinary'''
+|
+* Urinary frequency
+* Menstrual irregularities
+|
+* Menstrual irregularities
+|-
+|                           '''CNS'''
+|
+* [[Hyperreflexia]]
+* Proximal muscle weakness
+* Unilateral or bilateral [[tremor]]
+* [[Anxiety]], [[restlessness]], irritability, and emotional liability
+|
+* [[Hyporeflexia]]
+* Proximal muscle weakness
+* low mood, [[depression]]
+* [[Carpal tunnel syndrome]]
+|-
+|                         '''Extremities'''
+|
+* [[Fasciculations]]
+* [[Tremor|Tremors]] in the upper and lower extremity
+|
+* [[Clubbing]] in hypothyroid phase
+* Non-pitting [[edema]] of the lower extremities in [[hypothyroid]] phase
+* [[Muscle atrophy]]
 |}
-===Vital Signs===
-*Low-grade fever in hyperthyroid phase.
-*[[Tachycardia]] with regular pulse in hyperthyroid phase.
-*[[Bradycardia]] with regular pulse in hypothyroid phase.
-*Tachypnea in hyperthyroid phase.
-*High blood pressure with normal pulse pressure hyperthyroid phase.
-*Low blood pressure with normal pulse pressure hypothyroid phase.
-===Skin===
-'''Hyperthyroid phase''':
-Sweating increased.
-Onycholysis.
-Hyperpigmentation
-Pruritus and hives.
-Vitiligo and alopecia areata.
-Thinning of the hair
-Peritibail myxedoma in co-existing Grave's disease
-'''Hypothyroid phase''':
-Sweating decreased.
-Dry skin
-Hair coarse and brttile.
-Brittle nails.
-Nonpitting edema
-===HEENT===
-'''Hyperthyroid phase''':
-Stare and lid lag
-proptosis
-Gritty sensation in eyes
-'''Hypothyroid phase''':
-Icteric sclera
-Pallor
-===Neck===
-*Painless [[Thyromegaly]].
-===Lungs===
-* Decreased chest expansion due to respiratory muscles fatigue
-*Distant breath sounds in presence of plural effusion.
-*Enspiratory wheezing with delayed expiratory phase in patient due to exacerbation of asthma
-*Reduced [[tactile fremitus]] in presence of plural effusion.
-===Heart===
-*A low grade early [[systolic murmur]] best heard at the base mitral may be heard using the diaphgram of the otoscope in hyper-dynamic flow murmur in hyperthyroid phase.
-===Abdomen===
-*[[Abdominal distention]] in patients with constipation
-*[[Abdominal tenderness]] in the right upper abdominal quadrant with autoimmune hepatitis.
-*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
-*Dull note on percussion in peritoneal effusion.
-*Increased peristaltic movements in patients with hyperthyroid phase.
-===Back===
-*Point tenderness over lumber vertebrae in osteoporosis in hypo/hyperthyroid phase.
-*Costovertebral angle tenderness bilaterally osteoporosis in hypo/hyperthyroid phase.
-===Genitourinary===
-*Urinary frequency are common in hyperthyroidism phase .
-*Menstrual irregularities in hypo/hyperthyroid phase.
-===Neuromuscular===
-*Patient is usually oriented to persons, place, and time
-* Hyperreflexia in hyperthyroidism phase.
-* hyporeflexia in hypothyroid phase.
-* Proximal muscle weakness bilaterally in hypo/hyperthyroid phase.
-* lid lag 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)
-*NEUROPSYCHIATRIC : low mood, depression  in hypothyroid phase. Anxiety, restlessness, irritability, and emotional lability in hyperthyroidism phase.
-*Carpal tunnel syndrome in hypothyroid phase.
-*Joint pains, aches, and stiffness in hypothyroid phase.
-===Extremities===
-*[[Clubbing]] in hypothyroid phase.
-*Non-pitting [[edema]] of the lower extremities in hypothyroid phase.
-*Muscle atrophy in hypothyroid phase.
-*Fasciculations, tremors in the upper & lower extremity in hypothyroid phase.
 ==References==
@@ Line 158: / Line 107: @@
 {{WH}}
 {{WS}}
-[[Category: (name of the system)]]
+[[Category: Endocrinology]]