History and exam

Key diagnostic factors

common

presence of risk factors

A key risk factor is iodine deficiency.

palpable thyroid nodule

Characteristics of nodules are not diagnostic, but typically nodule is >3 cm if patient is hyperthyroid.[6]

younger age

Toxic thyroid adenomas are most common in younger adults (aged 20-40).

Other diagnostic factors

common

hyperphagia

A clinical feature of hyperthyroidism. Due to accelerated metabolism and higher basal metabolic rate requiring increased caloric intake.

weight loss

A clinical feature of hyperthyroidism. Due to accelerated metabolism and higher basal metabolic rate.

sweating/heat intolerance

A clinical feature of hyperthyroidism. Due to an increased metabolism leading to higher body temperature.

nervousness

Nervousness, irritability, and anxiety are common clinical features of hyperthyroidism.

palpitations

Palpitations may suggest a dysrhythmia such as atrial fibrillation. Dysrhythmias are more common in older patients.[28]

oligomenorrhoea

Menstrual disturbances are common in thyroid dysfunction. Oligomenorrhoea may be present in severe hyperthyroidism.[29]

hyperdefecation

A clinical feature of hyperthyroidism. Due to accelerated metabolism and higher basal metabolic rate.

dyspnoea

Pulmonary or cardiac aetiologies should be ruled out.[24]

stare or lid lag

Stigma of Graves' disease (exophthalmos) is absent.

tachycardia

A common sign of hyperthyroidism.

tremor

Usually a fine resting tremor.

warm moist skin

A common sign of hyperthyroidism. Due to accelerated metabolism and higher basal metabolic rate.

uncommon

muscle weakness

May be generalised or proximal.

hoarseness

Local causes should be ruled out.[24]

dysphagia

Oesophageal causes should be ruled out.[24]

choking

Local causes should be ruled out.[24]

mood change

Isolated depression or other mood change may be seen in apathetic hyperthyroidism, but is more common in older adults with toxic multinodular goitre.[28]

Risk factors

strong

iodine deficiency

Worldwide, iodine deficiency is the most common cause of nodular goitre.[8][21]

Iodine supplementation of foods has made nodular goitres and toxic nodules less common in many countries.[22]

weak

young adult age

Toxic adenomas most common in ages 20 to 40 years.

head and neck irradiation

The most common reason for head and neck irradiation is treatment for a malignancy such as lymphoma.

Accidental exposure to radiation may also be a risk factor.

family history of thyroid nodules

Development of nodular disease is influenced by environmental factors interacting with genetic background, sex, and age.[14]

female sex

Nodular thyroid disease is more common in women, although the underlying mechanisms are not well understood.[14]

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