History and exam

Key diagnostic factors

common

palpable thyroid nodule

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

younger age

Toxic thyroid adenomas are most common in younger adults (ages 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.[29]

oligomenorrhea

Menstrual disturbances are common in thyroid dysfunction. Oligomenorrhea may be present in severe hyperthyroidism.[30]

hyperdefecation

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

dyspnea

Pulmonary or cardiac etiologies should be ruled out.[21]

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 generalized or proximal.

hoarseness

Local causes should be ruled out.[21]

dysphagia

Esophageal causes should be ruled out.[21]

choking

Local causes should be ruled out.[21]

mood change

Isolated depression or other mood change may be seen in apathetic hyperthyroidism, but is more common in older adults with toxic multinodular goiter.[29]

Risk factors

strong

iodine deficiency

Worldwide, iodine deficiency is the most common cause of nodular goiter.[5][18]

Iodine supplementation of foods has made nodular goiters and toxic nodules less common in many countries.[19]

weak

young adult age

Toxic adenomas are 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.[11]

female sex

Nodular thyroid disease is more common in women, although the underlying mechanisms are not well understood.[11]

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