Toxic multinodular goiter physical examination: Difference between revisions
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* Flushing of skin | * Flushing of skin | ||
* [[Diaphoresis|Increased sweating]] | * [[Diaphoresis|Increased sweating]] | ||
* Smooth skin because of a decrease in the keratin layer | |||
* Onycholysis (loosening of the nails from the nail bed, Plummer's nails) and softening of the nails | |||
* Hyperpigmentation: it is mediated by accelerated cortisol metabolism and increased corticotropin secretion | |||
* Thinning of the hair | |||
=== Neck === | === Neck === | ||
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===HEENT=== | ===HEENT=== | ||
* | *Lid lag occurs in all patients with hyperthyroidism due to sympathetic overactivity. [4] | ||
===Lungs=== | ===Lungs=== | ||
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===Heart=== | ===Heart=== | ||
[[Heart]] rate is increased with wide pulse pressure.5]. | |||
Systolic hypertension, congestive heart failure, and dilated cardiomyopathy can occur in patients with severe hyperthyroidism.[6] | |||
Atrial fibrillation occurs in patients with hyperthyroidism | |||
In one study, 8 percent of all patients and 15 percent of patients between ages 70 to 79 developed atrial fibrillation within 30 days of the diagnosis of hyperthyroidism [8]. Even subclinical hyperthyroidism is associated with an increased rate of atrial ectopy and a threefold increased risk of atrial fibrillation (figure 1) [9]. | |||
In 60 percent of hyperthyroid patients with atrial fibrillation, the rhythm converts spontaneously to sinus rhythm when the hyperthyroidism is treated; in one study, all who spontaneously converted did so within four months after becoming euthyroid [10]. Among those who do not convert spontaneously to sinus rhythm and who undergo successful electrical cardioversion, the two-year risk of recurrent atrial fibrillation was 59 percent compared with 83 percent of patients whose atrial fibrillation was not associated with hyperthyroidism [11]. | |||
Anticoagulation should be considered in hyperthyroid patients with atrial fibrillation. In several studies, 10 to 40 percent of patients with hyperthyroidism and atrial fibrillation had an arterial embolus [12]. Left atrial enlargement, which is a risk factor for thrombus formation, is present in about 90 percent of hyperthyroid patients with atrial fibrillation and two percent of hyperthyroid patients with sinus rhythm. Based on these results, we usually anticoagulate hyperthyroid patients with atrial fibrillation. The role of anticoagulant therapy in patients with hyperthyroidism and atrial fibrillation is reviewed in detail separately. (See "Atrial fibrillation: Anticoagulant therapy to prevent embolization", section on 'Hyperthyroidism'.) | |||
Other abnormalities, including mitral valve prolapse, mitral regurgitation, and an increase in left ventricular mass index have also been reported. (See "Cardiovascular effects of hyperthyroidism" | |||
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Revision as of 17:30, 6 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Physical Examination
Appearance of the Patient
- Patients with thyroid adenoma are usually well-appearing.
- Vital Signs
- Tachycardia may be present.
Skin
- Flushing of skin
- Increased sweating
- Smooth skin because of a decrease in the keratin layer
- Onycholysis (loosening of the nails from the nail bed, Plummer's nails) and softening of the nails
- Hyperpigmentation: it is mediated by accelerated cortisol metabolism and increased corticotropin secretion
- Thinning of the hair
Neck
- Thyromegaly with solitary, non-tender thyroid nodules.[1]
- The nodules may be soft, smooth, and mobile. The mass moves with deglutition.
- Lymphadenopathy
HEENT
- Lid lag occurs in all patients with hyperthyroidism due to sympathetic overactivity. [4]
Lungs
Heart
Heart rate is increased with wide pulse pressure.5].
Systolic hypertension, congestive heart failure, and dilated cardiomyopathy can occur in patients with severe hyperthyroidism.[6]
Atrial fibrillation occurs in patients with hyperthyroidism
In one study, 8 percent of all patients and 15 percent of patients between ages 70 to 79 developed atrial fibrillation within 30 days of the diagnosis of hyperthyroidism [8]. Even subclinical hyperthyroidism is associated with an increased rate of atrial ectopy and a threefold increased risk of atrial fibrillation (figure 1) [9].
In 60 percent of hyperthyroid patients with atrial fibrillation, the rhythm converts spontaneously to sinus rhythm when the hyperthyroidism is treated; in one study, all who spontaneously converted did so within four months after becoming euthyroid [10]. Among those who do not convert spontaneously to sinus rhythm and who undergo successful electrical cardioversion, the two-year risk of recurrent atrial fibrillation was 59 percent compared with 83 percent of patients whose atrial fibrillation was not associated with hyperthyroidism [11].
Anticoagulation should be considered in hyperthyroid patients with atrial fibrillation. In several studies, 10 to 40 percent of patients with hyperthyroidism and atrial fibrillation had an arterial embolus [12]. Left atrial enlargement, which is a risk factor for thrombus formation, is present in about 90 percent of hyperthyroid patients with atrial fibrillation and two percent of hyperthyroid patients with sinus rhythm. Based on these results, we usually anticoagulate hyperthyroid patients with atrial fibrillation. The role of anticoagulant therapy in patients with hyperthyroidism and atrial fibrillation is reviewed in detail separately. (See "Atrial fibrillation: Anticoagulant therapy to prevent embolization", section on 'Hyperthyroidism'.)
Other abnormalities, including mitral valve prolapse, mitral regurgitation, and an increase in left ventricular mass index have also been reported. (See "Cardiovascular effects of hyperthyroidism"