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The Patient

  • General Features

    Age, gender, general comfort

  • Vital Signs

    Heart rate, blood pressure, resp rate, temp

  • Conscious State

    Alert, oriented, confused, obtunded

  • Body Habitus

    Weight gain ( ↓ ) / loss ( ↑ ), BMI, shape

  • Mental State

    Anxiety ( ↑ ),mental slowness ( ↓ )

The Hands

  • The Nails

    Onycholysis ( ↑ / ↓ ), peripheral cyanosis ( ↓ )

  • Clubbing

    Increased soft tissue in distal phalanges (Graves)

The Arms

  • Radial Pulse

    Tachycardia ( ↑ ) / bradycardia ( ↓ ), rhythm

  • Pemberton's Sign

    For thoracic outlet obstruction - retrosternal goitre

    Patient lifts arms as high as possible for 1 min, look for facial congestion and cyanosis

  • Biceps / Triceps Reflexes

    Reduced ( ↓ ) / normal / hyper-reflexive ( ↑ )

The Face

  • The Hair

    Alopecia ( ↑ )

  • The Skin

    Pigmentation ( ↑ ), thickening ( ↑ )

  • The Eyes

    Exophthalmos (Graves)

  • The Eyelids

    Lid retraction ( ↑ ), lid lag ( ↑ )

  • The Orbits

    Periorbital oedema ( ↓ ), loss of outer 1/3 of eyebrow ( ↓ )

  • The Mouth

    Swelling of tongue ( ↓ )

The Neck

  • Inspection

    Scars, veins, erythema, swelling, swallow

  • Palpation

    Size, shape, nodules, thrill, fixation, consistency

  • Percussion

    Upper part of manubrium

  • Auscultation

    Over each lobe for bruits

The Chest

  • Auscultate

    Systolic flow murmur ( ↑ ), crackles, pericardial / pleural rub

  • Auscultate Lung Fields

    Stridor, crackles, pleural rub

The Legs

  • Pretibial Myxoedema (Graves)

    Bilateral, firm, elevated dermal nodules

  • Non-Pitting Oedema ( ↓ )

  • Patellar / Ankle Reflexes

    Reduced ( ↓ ) / normal / hyper-reflexive ( ↑ )

References

 Cooper DS. Hyperthyroidism. Lancet. 2003; 362: 459-468. Dailey UG. Local Examination of the Thyroid Gland. Journal of the National Medical Association. 1946 Mar; 38(2): 60-61. Gaddipati RV, Meyer DR. Eyelid Retraction, Lid Lag, Lagophthalmos, and Von Graefe's Sign: Quantifying the Eyelid Features of Grave's Ophthalmopathy. Ophthalmology 2008. 115: 1083-1088.
Mechanisms in endocrinology: the crosstalk between thyroid gland and adipose tissue: signal integration in health and disease. Santini F, Marzullo P, Rotondi M, Ceccarini G, Pagano L, Ippolito S, Chiovato L, Biondi B.Eur J Endocrinol. 2014 Oct; 171(4):R137-52.
 Pearce EN. Thyroid hormone and obesity. Curr Opin Endocrinol Diabetes Obes. 2012 Oct; 19(5):408-13.
Roberts CG. Hypothyroidism. Lancet. 2004; 363: 792-803.

Snapshot: Initialising...