Diagnosis of Resistance to thyroid stimulating hormone
Resistance to thyroid stimulating hormone Diagnosis: Book Excerpts
Diagnostic Tests for Resistance to thyroid stimulating hormone: Online Medical Books
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Hyperthyroidism:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
The diagnosis of hyperthyroidism is usually straightforward and depends on a careful clinical history and physical examination, a high index of suspicion, and routine hormone determinations.
Confirming diagnosis The following tests confirm the disorder:
❑ Radioimmunoassay shows increased serum T4 and triiodothyronine (T3) concentrations.
❑ Thyroid scan reveals increased uptake of radioactive iodine (131I). This test is contraindicated if the patient is pregnant.
❑ TSH levels are decreased.
❑ Ultrasonography confirms subclinical ophthalmopathy.
❑ Antithyroglobulin antibody is positive in Grave’s disease.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Thyrotoxicosis/Hyperthyroidism:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Clinical features. Severity can vary with duration of illness, magnitude of hormone excess, age of the patient, and presence of disease in other organs, such as the heart. Typical patient complaints include thyroid enlargement (depending on cause), dyspnea on exertion, fatigue, proximal muscle weakness (often manifested by difficulty with stair climbing), palpitations, heat intolerance, excessive sweating, tremor, weight loss, nervousness or emotional lability (more common in younger patients), decreased menstrual flow, alterations in appetite, frequent bowel movements, and sleep disturbances (3). A recent viral illness can be an antecedent for subacute thyroiditis.
B. Effect of age. Older patients present with fewer clinical features than younger patients. Tachycardia, fatigue, and weight loss are the only clinical features found in more than 50% of patients aged more than 70 years (4).
Physical examination (PE)
A. Observation. Clothing may be loose because of weight loss. Clothing choices may suggest inappropriate heat intolerance, whereas the welcoming handshake may present warm moist hands with a fine tremor. Other possible observations include nervousness or restlessness, a characteristic stare with widened palpebral fissures, lid lag and infrequent blinking, and silky fine hair.
B. General examination. Vital sign abnormalities commonly include weight loss, sinus tachycardia, arrhythmias, and systolic hypertension with a widened pulse pressure. Systolic murmurs, cardiac enlargement, and, occasionally, overt heart failure may be found on cardiovascular examination (Chapters 7.4, 7.5 and 7.7). Besides the classic stare noted above, Graves’ disease can also present with proptosis (which may be asymmetric), ophthalmoplegia (with impaired conjugate eye movement and strabismus), orbital congestion (with periorbital edema and potential compression of the optic nerve), and inflammation of the conjunctiva and cornea. Pretibial myxedema, an unusual but pathognomonic finding in Graves’disease, is a painless raised thickening of the subcutaneous tissue, most often found in the anterior lower leg or dorsal foot. It produces a peau d’orange texture, which can be pruritic and hyperpigmented. Clubbing of the fingers and toes is also found in Graves’disease, but is very rare. An ovarian mass, usually unilateral, may indicate struma ovarii. Thyrotoxicosis (but not hyperthyroidism) can result from this teratoma, which infrequently produces thyroid hormone.
C. Thyroid examination. Inspect the neck below the thyroid cartilage from the front and side. During palpation, approach the patient from the front or from behind and palpate using the fingers or thumbs. Having the patient swallow during both inspection and palpation causes the thyroid to move and aids in developing a three-dimensional impression of the gland. The size, consistency, and tenderness of the gland are important, as are the presence and characteristics of any nodules. Auscultation of a bruit over the gland correlates with increased vascularity, usually indicative of Graves’disease.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
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