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:

Physical Examination

Appearance of the Patient

• Patients with thyroid adenoma are usually well-appearing.
• Tachycardia may be present.

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
• Cholestiatosis

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

• Tremor-high frequency and low amplitude and 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