Symptoms and signs of hyperthyroidism
The symptoms and signs of hyperthyroidism affect many systems:
Symptomatology and signs vary with age and with the underlying aetiology.
- The eye signs, pretibial myxoedema and thyroid acropachy occur only in Graves' disease. Pretibial myxoedema is an infiltration on the shin, essentially occurring only with eye disease (see below). Thyroid acropachy is very rare and consists of clubbing, swollen fingers and periosteal new bone formation.
- In the elderly , a frequent presentation is with atrial fibrillation, other tachycardias and/or heart failure, often with few other signs. Thyroid function tests are mandatory in any patient with atrial fibrillation.
- Children frequently present with excessive height or excessive growth rate, or with behavioural problems such as hyperactivity. They may also show weight gain rather than loss.
- So-called 'apathetic thyrotoxicosis' in some elderly patients presents with a clinical picture more like hypothyroidism . There may be very few signs and a high degree of clinical suspicion is essential.
Diagnosis of hyperthyroidism
Hyperthyroidism is often clinically obvious but treatment should never be instituted without biochemical confirmation.
Differentiation of the mild case from anxiety states may be difficult; useful positive clinical markers are eye signs, a diffuse goitre, proximal myopathy and wasting. The hyperdynamic circulation with warm peripheries seen with hyperthyroidism can be contrasted with the clammy hands of anxiety.