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Showing posts with label thyrotoxicosis. Show all posts
Showing posts with label thyrotoxicosis. Show all posts

How to elicit the eye signs of thyroid disease an OSCE guide

Following are the important eye sign in thyroid disease.
1.Exophthalmos: Unilateral or bilateral.
Comment on the widened palpebral fissure, visibility of the sclera above and below the limbus.
3. Stellwag's sign Observe for retraction of upper eyelid and Infrequent blinking.
5.Moebles sign: Look for Inability to converge the eyes.

How to elicit Joffroy's sign an OSCE guide

In Joffroy's sign there is a lack of wrinkling of the forehead when a patient looks up with the head bent forwards

Joffroys sign is a sign of hyperthyroidism.It is elicited as follows
  • Patient's face is inclined downwards.
  • Patient attempts to look up.
  • Look  for absence of wrinkles on the forehead.

How to elicit Von Graefe's sign:an OSCE guide

Von Graefes sign is an important eye sign in hyperthyroidism.It is elicited as follows
  • The patient looks straight ahead.
  • Ask the patient to look down.
  • Look for a lag of the upper eyelid.
It is the lagging of the upper eyelid on downward rotation of the eye and indicate  underlying  Graves' Disease
The terms lid lag and von Graefe's sign have been used interchangeably in the past; but, they are distinct signs of downgaze-related upper eyelid static position and dynamic movement, respectively.

What are the clinical manifestations of thyrotoxicosis?

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 
Fatigue and weakness
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
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 
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.

Thyroid ophthalmopathy