A site for medical students - Practical,Theory,Osce Notes

What are the clinical manifestations of thyrotoxicosis?

The clinical presentation of thyrotoxicosis  depends on the  
  • Severity of thyrotoxicosis 
  • The duration of disease
  • Individual susceptibility to excess levels of  thyroid hormone 
  • Age of patient
Common symptoms of thyrotoxicosis are the following
Weightloss inspite of increased appetite.
Heat intolerance and sweating
Hyperactivity, irritability, dysphoria 
Palpitations
Fatigue and weakness
Diarrhea
Polyuria 
Insomnia and impaired concentration
Oligomenorrhea, loss of libido

Signs of thyrotoxicosis
Tachycardia; atrial fibrillation is commonly seen in the elderly
The high cardiac output produces a  
Bounding pulse
Widened pulse pressure 
Aortic systolic murmur 
Warm, moist skin 
Fine tremor of hands
Goiter- diffusely enlarged thyroid,firm,bruit may be heard over the thyroid
Muscle weakness, proximal myopathy 
Hyperreflexia 
Gynecomastia 
Lid retraction or lidlag due to sympathetic overactivity 
Ophthalmopathy and dermopathy are specific for Graves' disease

Thyroid dermopathy
Seen in <5% of patients with Graves' disease, usually associated with moderate or severe ophthalmopathy.
It is most frequent over the anterior and lateral aspects of the lower leg so called as pretibial myxedema), but the  skin changes can occur at other sites,  particularly after trauma. 
The typical lesion of thyroid dermopathy is a noninflammed, indurated plaque which is deep pink or purple in  color and an orange skin appearance. 
Nodular involvement of skin can occur, and the condition may rarely extend over the whole lower leg and foot, thus  mimicking elephantiasis
Thyroid acropachy 
This is a form of clubbing found in <1% of Graves' disease. It is strongly associated with thyroid dermopathy.




Thyroid ophthalmopathy