Toxic multinodular goiter physical examination

Overview
The clinical features of toxic multinodular goiter includes flushing, diaphoresis, smooth
skin, onycholysis, hyperpigmentation, thinning of the hair, thyromegaly,lymphadenopathy, lid
lag, shortness of breath on exertion, hypoxemia, hypercapnia, tachycardia, atrial fibrillation, weight
loss, increased appetite, anorexia, dysphagia, increased urinary
frequency, enuresis, gynecomastia, reduced libido, erectile dysfunction, psychosis, agitation,
and depression, anxiety, restlessness, irritability, and emotional lability. Some other features which
may be seen are insomnia, confusion, poor orientation and immediate recall, amnesia, and
constructional difficulties, peripheral neuropathy, carpal tunnel syndrome, tremors.

Physical Examination
Appearance of the Patient
Physical examination is as follows:[1][2][3][3][4][5][6][7][3][4][5][8]

 Patients with thyroid adenoma are usually well-appearing.

Skin

 Flushing
 Diaphoresis
 Smooth skin
 Onycholysis and nail softening
 Hyperpigmentation
 Thinning of the hair
Neck

 Thyromegaly with solitary, non-tender thyroid nodules.

 Soft, smooth, and mobile nodules.
 Lymphadenopathy
HEENT

 Lid lag occurs in all patients with hyperthyroidism due to sympathetic overactivity.
Lungs

 Shortness of breath on exertion

 Hypoxemia
 Hypercapnia
 Tracheal compression from a large goiter.
 Pulmonary hypertension.
Heart

 Tachycardia with wide pulse pressure.

 Systolic hypertension
 Congestive heart failure
 Dilated cardiomyopathy
 Atrial fibrillation
Abdomen

 Weight loss
 Increased appetite
 Anorexia in older hyperthyroid patients.
 Dysphagia
Genitourinary

 Increased urinary frequency and nocturia

 Enuresis is common in children.
 Gynecomastia
 Reduced libido
 Erectile dysfunction.
Neuromuscular

 Psychosis, agitation, and depression.

 Anxiety, restlessness, irritability, and emotional lability.
 Insomnia
 Cognitive impairments such as confusion, poor orientation and immediate recall, amnesia, and
constructional difficulties.
 Peripheral neuropathy
 Carpal tunnel syndrome
Extremities

 High and low frequency amplitude tremors which can involve the face and head as well as the
extremities.
 Myopathy
 Muscle weakness with or without atrophy and myalgias.
 Proximal and distal weakness.
 Deep tendon reflexes are usually normal or increased,
 Paresthesias, due to coexisting polyneuropathy
Bone

 Osteoporosis and an increased fracture