1. Observe: exophthalmos, goitre, neck scar, thyroid acropachy, pretibial
2. Get patient to stretch out hands for tremor (put a
piece of paper on the
3. Feel the hands for warmth and check pulse for rate and character.
4. Examine the neck and feel the goitre (get patient to
swallow some water),
5. Examine the eyes for lid lag.
6. Examine the tendon reflexes.
The thyroid status is often asked in the examination after you have examined a patient with thyroid eye disease. In the majority of cases, the patient is euthyroid.
Thyroid eye disease is associated with Grave's disease and therefore look out especially for acropachy and pretiabial myxoedema (the last two plus the eye signs form the triad of Grave's disease).
Do not forget to revise the medication used in treating hyperthyroidism which are propyluracil, carbimazole and radioactive iodine and their individual side effects such as agranulocytosis with propyluracila and carbimazole; and hypothyroidism with radioactive iodine.
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