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
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.
