See also hypothyroidism, hyperthyroidism, odd TFTs and thyroid lumps and nodules
Clinical assessment of thyroid status
- History
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- Do you prefer hot or cold weather?
- Bowels and weight loss
- Menstruation
- Anxiety / depression
- Sweatiness, tremor
- SOB, chest pain, palpitations
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- Examination
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- Hands – sweaty, tremor, acropatchy
- Pulse
- Proximal muscle weakness
- Eye signs
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- Lid lag, lid retraction, chemosis, diplopia, periorbital oedema, ophthalmoplegia central scotoma
- Note that the thyroid stare (lid retraction) is due to sympathetic activation in thyrotoxicosis, and is not the same as proptosis which suggest Graves
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- Goitre
- Pretibial myxoedema
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- Clinical assessment of goitre/neck swelling
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- Palpate – size, smoothness/nodularity, tenderness, compressibility
- Check its movement on swallowing and tongue protrusion
- Percuss for retrosternal extension
- Check cervical lymph nodes
- Assess for signs of compression – stridor, tracheal deviation, dysphagia, hoarseness, suffusion on elevation of arms (Pemberton’s sign)
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When to check TFTs
- If symptoms of thyroid disease
- Newly diagnosed AF
- Hyperlipidaemia
- Osteoporosis / fractures
- Infertility / menstrual disturbance
- Thyroid lump
- Pituitary lesion
- As part of a confusion screen
- Annual screening done for those with Downs syndrome, Turners syndrome, T1 DM, Coeliacs, post thyroiditis, those on certain medications, after neck irradiation, after radio-iodine
- Avoid checking TFTs during an acute illness (unless you suspect the illness is the result of thyroid disease)
Thyroid antibodies
- Anti-TPO – Positive in normal individuals and in autoimmune thyroid disease. Positive/Negative test (levels not relevant). No need to repeat
- Anti-thyroglobulin – marker of thyroid cancer (once gland removed)
- TSH-receptor antibodies (TRAb) – always test in hyperthyroid patients. Highly sensitive and specific for Graves (near 100%). Titre can give indication of disease severity and predicts eye disease
How to explain test results to patients
- People can feel well even when TFTs are outside the normal range
- Even when no symptoms, treatment is advised to reduce complications
- Symptoms can lag being treatment changes for weeks