Postpartum thyroiditis physical examination: Difference between revisions

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==Overview==
==Overview==
The presence of signs of hyperthyroidism or hypothyroidism in postpartum period on physical examination is highly suggestive of PPT.
The presence of signs of [[hyperthyroidism]] or [[hypothyroidism]] in postpartum period on physical examination is highly suggestive of [[Postpartum thyroiditis|PPT.]]
==Physical Examination==
==Physical Examination==
The presence of signs of hyperthyroidism or hypothyroidism in postpartum period  on physical examination is highly suggestive of PPT.
The presence of signs of [[hyperthyroidism]] or [[hypothyroidism]] in postpartum period  on physical examination is highly suggestive of PPT.
<ref name="pmid10874538">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }} </ref>
<ref name="pmid10874538">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538  }} </ref>
<ref name="pmid15157842">{{cite journal| author=Stagnaro-Green A| title=Postpartum thyroiditis. | journal=Best Pract Res Clin Endocrinol Metab | year= 2004 | volume= 18 | issue= 2 | pages= 303-16 | pmid=15157842 | doi=10.1016/j.beem.2004.03.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15157842  }} </ref>
<ref name="pmid15157842">{{cite journal| author=Stagnaro-Green A| title=Postpartum thyroiditis. | journal=Best Pract Res Clin Endocrinol Metab | year= 2004 | volume= 18 | issue= 2 | pages= 303-16 | pmid=15157842 | doi=10.1016/j.beem.2004.03.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15157842  }} </ref>
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| style="padding: 5px 5px; background: #F5F5F5;" |
* Stare and lid lag, proptosis, Gritty sensation in eyes
* Stare and lid lag, proptosis, Gritty sensation in eyes
* lid lag
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| style="padding: 5px 5px; background: #F5F5F5;" |
* Icteric sclera, Pallor
* Icteric sclera, Pallor
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* Point tenderness over lumber vertebrae in [[osteoporosis]]
* Point tenderness over lumber vertebrae in [[osteoporosis]]
*Costovertebral angle tenderness bilaterally [[osteoporosis]]
*Costovertebral angle tenderness bilaterally [[osteoporosis]]
|-
|                    '''Genitourinary'''
|
* Urinary frequency
* Menstrual irregularities
|
* Menstrual irregularities
|-
|'''CNS'''
|
* Hyperreflexia
* Proximal muscle weakness
* Unilateral/bilateral tremor
* Anxiety, restlessness, irritability, and emotional liability
|
* Hyporeflexia
* Proximal muscle weakness
* low mood, depression
* Carpal tunnel syndrome
|-
|'''Extremities'''
|Fasciculations, tremors in the upper & lower extremity
|
* [[Clubbing]] in hypothyroid phase
* Non-pitting [[edema]] of the lower extremities in hypothyroid phase
* Muscle atrophy
|}
|}
 
*
===Neck===
*Painless [[Thyromegaly]].
 
===Lungs===
* Decreased chest expansion due to respiratory muscles fatigue
*Distant breath sounds in presence of plural effusion.
*Enspiratory wheezing with delayed expiratory phase in patient due to exacerbation of asthma
*Reduced [[tactile fremitus]] in presence of plural effusion.
 
===Heart===
*A low grade early [[systolic murmur]] best heard at the base mitral may be heard using the diaphgram of the otoscope in hyper-dynamic flow murmur in hyperthyroid phase.
 
===Abdomen===
*[[Abdominal distention]] in patients with constipation
*[[Abdominal tenderness]] in the right upper abdominal quadrant with autoimmune hepatitis.
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Dull note on percussion in peritoneal effusion.
*Increased peristaltic movements in patients with hyperthyroid phase.
 
===Back===
*Point tenderness over lumber vertebrae in osteoporosis in hypo/hyperthyroid phase.
*Costovertebral angle tenderness bilaterally osteoporosis in hypo/hyperthyroid phase.
 
===Genitourinary===
*Urinary frequency are common in hyperthyroidism phase .
*Menstrual irregularities in hypo/hyperthyroid phase.
 
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
* Hyperreflexia in hyperthyroidism phase.
* hyporeflexia in hypothyroid phase.
* Proximal muscle weakness bilaterally in hypo/hyperthyroid phase.
* lid lag suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
*NEUROPSYCHIATRIC : low mood, depression  in hypothyroid phase. Anxiety, restlessness, irritability, and emotional lability in hyperthyroidism phase.
*Carpal tunnel syndrome in hypothyroid phase.
*Joint pains, aches, and stiffness in hypothyroid phase.
 
===Extremities===
*[[Clubbing]] in hypothyroid phase.
*Non-pitting [[edema]] of the lower extremities in hypothyroid phase.
*Muscle atrophy in hypothyroid phase.
*Fasciculations, tremors in the upper & lower extremity in hypothyroid phase.


==References==
==References==

Revision as of 19:09, 13 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Overview

The presence of signs of hyperthyroidism or hypothyroidism in postpartum period on physical examination is highly suggestive of PPT.

Physical Examination

The presence of signs of hyperthyroidism or hypothyroidism in postpartum period on physical examination is highly suggestive of PPT. [1] [2]

Appearance of the Patient

  • Patients with PPT usually appear tired or irritable depend of the phase of disease.
Systems involved Hyperthyroidism Hypothyroidism
Vital Signs
  • Low-grade fever,Tachycardia with regular pulse or irregular pulse,Tachypnea, High blood pressure
  • Bradycardia with regular pulse, Low blood pressure
Skin
  • Sweating decreased, Dry skin, Hair coarse and brttile, Brittle nails, Nonpitting edema
HEENT
  • Stare and lid lag, proptosis, Gritty sensation in eyes
  • lid lag
  • Icteric sclera, Pallor
Abdomen
  • Increased peristaltic movements in patients
Back
Genitourinary
  • Urinary frequency
  • Menstrual irregularities
  • Menstrual irregularities
CNS
  • Hyperreflexia
  • Proximal muscle weakness
  • Unilateral/bilateral tremor
  • Anxiety, restlessness, irritability, and emotional liability
  • Hyporeflexia
  • Proximal muscle weakness
  • low mood, depression
  • Carpal tunnel syndrome
Extremities Fasciculations, tremors in the upper & lower extremity
  • Clubbing in hypothyroid phase
  • Non-pitting edema of the lower extremities in hypothyroid phase
  • Muscle atrophy

References

  1. ↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
  2. ↑ Stagnaro-Green A (2004). "Postpartum thyroiditis". Best Pract Res Clin Endocrinol Metab. 18 (2): 303–16. doi:10.1016/j.beem.2004.03.008. PMID 15157842.

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