General:
- Hypothyroidism: Weight gain, myxoedema facies, dry thickened skin, deep voice.
- Hyperthyroidism: Weight loss, anxiety, thyroid “frightened” facies
Vital signs
- Hypothyroidism
- Pulse- bradycardia, small volume
- Blood pressure
- Respiratory rate
- Temperature- may be low (myxoedema coma)
- BMI – may be elevated
- Hyperthyroidism
- Pulse- tachycardia, AF, collapsing character
- Blood pressure- hypertension
- Respiratory rate
- Temperature
- BMI
Hands and arms
hypothyroidism: Cold, dry palms. CRT reduced, peripheral cyanosis. Palmar surface of hands for anaemia and hypercarotenaemia. Check for proximal muscle weakness by asking patients to abduct arms.
Hyperthyroidism: Warm, sweaty palms. Nails for onycholysis (Plummer’s nail; separation of nail plate from nail bed) and thyroid acropathy (clubbing, swollen fingers and periosteal new bone formation). Palmar surface of hands for erythema. Check for tremor and for proximal muscle weakness by asking patients to abduct arms, check for hyperreflexia by testing for the biceps reflex.
Face
- Hypothroidism: Alopecia, dry thin hair, yellow discolouration of skin due to hypercarotenaemia, vitiligo. Eyes for periorbital oedema, loss of outer third of eyebrows and xanthelasma and anaemia. Swelling of tongue.
Eyes
- Look for the thyroid stare and lid retraction.
- Check for exophthalmos. Look from the front with patient looking straight ahead and then looking from behind over patient’s forehead for protrusion. Exophthalmos is very specific for Grave’s disease.
- Test for lid lag. Ask the patient to follow your finger as you bring it down from the upper to the lower part of the visual field. The upper lid lags behind the descent of the eyeball. These signs are related to sympathetic overactivity and are not specific for Grave’s disease.
An ocular examination including vision, anterior segment examination for chemosis, conjunctivitis, corneal ulcers; ocular motility, pupillary and fundus examination for any disc swelling or atrophy needs to be performed