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Thyroid disorders may affect multiple organ systems,
resulting in a variety of clinical manifestations. Thyroid disease may present emergently,
little by little (hyperthyroidism, hypothyroidism), or asymptomatically (a thyroid
nodule). In this article, we will primarily discuss the case of hyperthyroidism (increased
thyroid function) and hypothyroidism (decreased thyroid function).
Hyperthyroidism
Symptoms
Symptoms include nervousness, sweating, heat intolerance, fast heart beat, fatigue,
weakness, weight loss (often despite an increased caloric intake), eye complaints,
decreased menstrual flow in women, more frequent bowel movements, irritability, and
emotional lability.
Diagnosis
A. A physical examination may reveal tachycardia (fast heart beat), high blood pressure,
hand tremor, nail loss, warm and moist skin, pretibial myxedema (enlargement of the lower
extremities), lid lag, enlargement of the thyroid, etc. The eyes should be examined
carefully. Thyroid examination may reveal a sound on the thyroid (bruit) when a
stethoscope is placed on it. Size, texture, and presence of nodules in the thyroid should
be carefully evaluated on physical exam.
B. The laboratory evaluation has two goals: first, to document the presence of
hyperthyroidism and second, to determine its cause. Thyroid function tests are determined
to establish whether thyroid function is infact increased and whether this originates in
the thyroid itself or as a consequence from the brain.
C. Radiologic evaluation and nuclear thyroid scan studies may be performed.
Treatment
A. Beta-blockers provide rapid control of hyperthyroid symptoms.
B. Antithyroid drugs, such as Tapazole inhibit thyroid hormone synthesis.
C. Inorganic iodine inhibits thyroid hormone release.
D. Radioactive iodine is commonly used as initial therapy in certain cases.
E. Surgery is infrequently recommended, except for the patient with a very large thyroid
(especially if adjacent structures are compromised), or pregnant women intolerant of
medications.
Hypothyroidism
Symptoms
Symptoms include weakness, fatigue, lethargy, cold intolerance, weight gain, dry skin,
decreased sweating, easy bruising, exertional shortness of breath, constipation, menstrula
irregularities in women, joint pain, and impaired cognition (memory, speech, attention).
Diagnosis
A. Examine the patient for decreased heart rate, cool, dry skin, brittle nails,
periorbital or hand enlargement thyroid enlargement, etc.
B. Laboratory evaluation for determination of thyroid function tests. This establishes
whether thyroid function is decreased and whether its origin is in the thyroid itself or
in the brain.
Treatment
Treatment is best accomplished with levothyroxine, a thyroid hormone.
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