Thyroid Diseases

Features associated with hyperthyroidism General Heat intolerance Excessive sweating because of increased cutaneous blood flow Weight loss despite increased appetite Frequent bowel movements (because of intestinal hypermotility) Weakness, fatigue Onycholysis Infiltrative dermopathy, especially in the pretibial area (pretibial myxedema) Eyes Lid lag; : caused by adrenergic overactivity, which results in spasming of the smooth muscle of the levator palpebrae superioris Lid retraction; : “staring look” Graves ophthalmopathy(exophthalmos, edema of the periorbital tissue) Goiter Diffuse, smooth, nontender goiter; often audible bruit at the superior poles Also seen in subacute thyroiditis, toxic adenoma, and toxic MNG Cardiovascular Tachycardia Palpitations, irregular pulse (due to atrial fibrillation/ectopic beats) Hypertension with widened pulse pressure - Systolic pressure is increased due to increased heart rate and cardiac output. - Diastolic pressure is decreased due to decreased peripheral vascular resistance. Thyrotoxicosis-induced cardiac failure; : elderly patients often present with features of cardiac failure (e.g., pedal edema, exertional dyspnea). Abnormal heart rhythms, including atrial fibrillation Chest pain Musculoskeletal Fine tremor of the outstretched fingers Hyperthyroid myopathy: a condition of muscle weakness, pain, and atrophy associated with hyperthyroidism (e.g., from Graves disease, thyroiditis) - Predominantly affects individuals > 40 years of age - Can develop acutely or several weeks to months after the onset of hyperthyroidism. - Typically affects proximal muscles (e.g., hip flexors, quadriceps) more than distal muscles - Serum creatine kinase levels are most often normal - Treatment of hyperthyroidism often reverses myopathy Osteopathy: osteoporosis due to the direct effect of T3 on osteoclastic bone resorption , fractures (in the elderly) Endocrinological Female: oligo/amenorrhoea, anovulatory infertility, dysfunctional uterine bleeding Male: gynecomastia, decreased libido, infertility, erectile dysfunction Glucose intolerance [16] - ↓ Insulin sensitivity of peripheral tissue - Impaired insulin secretion Neuropsychiatric system Anxiety Emotional instability Depression Restlessness Insomnia Tremoulousness (results from the hyperadrenergic state) Hyperreflexia Resource :AMBOSS

Features associated with hyperthyroidism

General

Heat intolerance
Excessive sweating because of increased cutaneous blood flow
Weight loss despite increased appetite
Frequent bowel movements (because of intestinal hypermotility)
Weakness, fatigue
Onycholysis
Infiltrative dermopathy, especially in the pretibial area (pretibial myxedema)

Eyes

Lid lag; : caused by adrenergic overactivity, which results in spasming of the smooth muscle of the levator palpebrae superioris
Lid retraction; : “staring look”
Graves ophthalmopathy(exophthalmos, edema of the periorbital tissue)

Goiter

Diffuse, smooth, nontender goiter; often audible bruit at the superior poles
Also seen in subacute thyroiditis, toxic adenoma, and toxic MNG

Cardiovascular

Tachycardia
Palpitations, irregular pulse (due to atrial fibrillation/ectopic beats)
Hypertension with widened pulse pressure
- Systolic pressure is increased due to increased heart rate and cardiac output.
- Diastolic pressure is decreased due to decreased peripheral vascular resistance.
Thyrotoxicosis-induced cardiac failure; : elderly patients often present with features of cardiac failure (e.g., pedal edema, exertional dyspnea).
Abnormal heart rhythms, including atrial fibrillation
Chest pain

Musculoskeletal

Fine tremor of the outstretched fingers

Hyperthyroid myopathy: a condition of muscle weakness, pain, and atrophy associated with hyperthyroidism (e.g., from Graves disease, thyroiditis)
- Predominantly affects individuals > 40 years of age
- Can develop acutely or several weeks to months after the onset of hyperthyroidism.
- Typically affects proximal muscles (e.g., hip flexors, quadriceps) more than distal muscles
- Serum creatine kinase levels are most often normal
- Treatment of hyperthyroidism often reverses myopathy
Osteopathy: osteoporosis due to the direct effect of T3 on osteoclastic bone resorption , fractures (in the elderly)

Endocrinological

Female: oligo/amenorrhoea, anovulatory infertility, dysfunctional uterine bleeding
Male: gynecomastia, decreased libido, infertility, erectile dysfunction
Glucose intolerance [16]
- ↓ Insulin sensitivity of peripheral tissue
- Impaired insulin secretion

Neuropsychiatric system

Anxiety
Emotional instability
Depression
Restlessness
Insomnia
Tremoulousness (results from the hyperadrenergic state)
Hyperreflexia

Resource :AMBOSS