General Inspection
Overt signs of hypo/hyperthyroidism
Body habitus
Goitre
Facies
Peripheries
Nail changes
Large hands
Phalen’s test
Skin
- Necrobiosis lipoidica
- Atrophy
- BSL checks
- Ulceration
Pulse
BP - BP drop, autonomic dysfunction
Face & Neck
Face
- Hair: alopecia, thinning
- Eyes: Proptosis, stare, conjunctival injection
- Visual field defects
- Mouth: ulcers
- Acne
- Hirsutism
- Moon facies, plethora
- Frontal bossing
- Fundoscopy - papilloedema
Mouth - thrush, macroglossia
Hoarse voice
Neck:
- Visual: scars, sweeling, skin changes
- Swallow - notable lumps, mobile lesions
- Palpate
> Back: thyroid contours (size, shape, borders, lumps, pain, thrills), lymph nodes
> Front: repeat, carotid arteries, trachea, sternomastoid function
- Percuss over upper manubrium
- Auscultate: thyroid bruit, carotid bruit
Pemberton sign
JVP
Causes of goitre
- Idiopathic
- Puberty, pregnancy, postpartum
- Graves
- Thyroiditis: Hashimoto, subacute
- Iodine deficiency
- Goitrogens: iodine excess, drugs (Li, phenylbutazone)
- Inborn errors of thyroid hormone synthesis
Causes of thyrotoxicosis
PRIMARY
- Graves
- Toxic adenoma
- MNG
- Hashimoto
- Iodine induced
- Excess hormone replacement
- Postpartum thyroiditis
- Drugs (Amiodarone, Li)
SECONDARY
- Pit or ectopic TSH secretion
- Hydatidiform mole
- Choriocarcinome
- Struma ovarii
- Factitious lol u lie bish
Cause of hypothyroidism
PRIMARY Without goitre - Idiopathic - Treatment - Agenesis - Unresponsiveness to TSH With goitre - Chronic thyroiditis - Drugs - Endemic iodine deficiency - Iodine induced - Inborn enzyme errors
SECONDARY
- Pit lesions
TERTIARY
- Hypothalamic lesions
TRANSIENT
- Treatment withdrawn
- Subacute thyroiditis
- Postpartum
Chest, Abdo, legs
Cardiac exam
Lungs
Telangiectasia
Acanthosis nigricans
Pigmentation
Abdo
- Signs of cushings
- Bruising
- Striae
- Injection sites
Legs
- Wasting
- Pretibial myxedema
- Skin changes
- Squat test
- Charcot joints
- Ulcers
PVD - temperature, pulses, oedema
Neuro exam
- Sensation
- Pain
- Strength
Urinanalysis
Cause of Addisons
IATROGENIC
PRIMARY - AI - Polyglandular TB Infiltration: amyloid, sarcoid, mets Demyelinating Drugs: heparin, haemorrhage, aminogylcosides, ketoconazole HIV
SECONDARY
Pit disease
Hypothalamus disease
