Postpartum thyroiditis physical examination: Difference between revisions

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{{Postpartum thyroiditis}}
{{Postpartum thyroiditis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{SKA}}  


==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="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>


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with PPT usually appear tired or irritable depend of the phase of disease.
*Patients with PPT usually appear tired or irritable depend of the phase of disease.
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
===Vital Signs===
| valign="top" |
 
|+
*Low-grade fever in hyperthyroid phase.
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Systems involved}}
*[[Tachycardia]] with regular pulse in hyperthyroid phase.
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Hyperthyroidism}}
*[[Bradycardia]] with regular pulse in hypothyroid phase.
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Hypothyroidism}}
*Tachypnea in hyperthyroid phase.
|-
*High blood pressure with normal pulse pressure hyperthyroid phase.
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Vital Signs
*Low blood pressure with normal pulse pressure hypothyroid phase.
| style="padding: 5px 5px; background: #F5F5F5;" |
 
* Low-grade fever
===Skin===
* [[Tachycardia]] with regular pulse or irregular pulse
'''Hyperthyroid phase''':
* [[Tachypnea]]
 
* High blood pressure
Sweating increased.
| style="padding: 5px 5px; background: #F5F5F5;" |
 
* [[Bradycardia]] with regular pulse
Onycholysis.
* Low blood pressure
 
|-
Hyperpigmentation
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Skin
 
| style="padding: 5px 5px; background: #F5F5F5;" |
Pruritus and hives.
* Sweating increased
 
* [[Onycholysis]]
Vitiligo and alopecia areata.
* Hyperpigmentation
 
* [[Pruritus]] and hives
Thinning of the hair
* Vitiligo and [[alopecia areata]]
 
* Thinning of the hair
Peritibail myxedoma in co-existing Grave's disease
* Pretibial myxedema in co-existing [[Grave's disease]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Hypothyroid phase''':
* Sweating decreased
 
* Dry skin
Sweating decreased.
* Hair coarse and brttile
 
* Brittle nails
Dry skin
* [[Nonpitting edema|Non-pitting edema]]
 
|-
Hair coarse and brttile.
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |HEENT
 
| style="padding: 5px 5px; background: #F5F5F5;" |
Brittle nails.
* Stare and lid lag
 
* [[Proptosis]]
Nonpitting edema
* Gritty sensation in eyes
 
* Lid lag
===HEENT===
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Hyperthyroid phase''':
* [[Icteric sclera]]
 
* [[Pallor]]
Stare and lid lag
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Abdomen
proptosis
| style="padding: 5px 5px; background: #F5F5F5;" |
 
* [[Abdominal distention]] in patients with [[constipation]]
Gritty sensation in eyes
*[[Abdominal tenderness]] in the right upper abdominal quadrant with autoimmune hepatitis  
 
*[[Hepatomegaly]] or [[splenomegaly]] or [[hepatosplenomegaly]]
'''Hypothyroid phase''':
*Dull note on [[percussion]] in [[peritoneal effusion]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |
Icteric sclera
* Increased peristaltic movements in patients
 
|-
Pallor
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Back
 
| style="padding: 5px 5px; background: #F5F5F5;" |
===Neck===
*Point tenderness over lumbar vertebrae in [[osteoporosis]]
*Painless [[Thyromegaly]].
*Costovertebral angle tenderness bilaterally [[osteoporosis]]
 
| style="padding: 5px 5px; background: #F5F5F5;" |
===Lungs===
* Point tenderness over lumbar vertebrae in [[osteoporosis]]
* Decreased chest expansion due to respiratory muscles fatigue
*Costovertebral angle tenderness bilaterally [[osteoporosis]]
*Distant breath sounds in presence of plural effusion.
|-
*Enspiratory wheezing with delayed expiratory phase in patient due to exacerbation of asthma
|                                          '''Genitourinary'''
*Reduced [[tactile fremitus]] in presence of plural effusion.
|
 
* Urinary frequency
===Heart===
* Menstrual irregularities
*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.
|
 
* Menstrual irregularities
===Abdomen===
|-
*[[Abdominal distention]] in patients with constipation  
|                          '''CNS'''
*[[Abdominal tenderness]] in the right upper abdominal quadrant with autoimmune hepatitis.
|
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
* [[Hyperreflexia]]
*Dull note on percussion in peritoneal effusion.
* Proximal muscle weakness
*Increased peristaltic movements in patients with hyperthyroid phase.
* Unilateral or bilateral [[tremor]]
 
* [[Anxiety]], [[restlessness]], irritability, and emotional liability
===Back===
|
*Point tenderness over lumber vertebrae in osteoporosis in hypo/hyperthyroid phase.
* [[Hyporeflexia]]
*Costovertebral angle tenderness bilaterally osteoporosis in hypo/hyperthyroid phase.
* Proximal muscle weakness
 
* low mood, [[depression]]
===Genitourinary===
* [[Carpal tunnel syndrome]]
*Urinary frequency are common in hyperthyroidism phase.
|-
 
|                        '''Extremities'''
===Neuromuscular===
|
*Patient is usually oriented to persons, place, and time
* [[Fasciculations]]
* Altered mental status
* [[Tremor|Tremors]] in the upper and lower extremity
* Glasgow coma scale is ___ / 15
|
* Clonus may be present
* [[Clubbing]] in hypothyroid phase
* Hyperreflexia / hyporeflexia / areflexia
* Non-pitting [[edema]] of the lower extremities in [[hypothyroid]] phase
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* [[Muscle atrophy]]
* Muscle rigidity
|}
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) 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)
 
===Extremities===
*[[Clubbing]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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[[Category: (name of the system)]]
[[Category: Endocrinology]]

Latest revision as of 17:56, 10 November 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
Skin
HEENT
  • Stare and lid lag
  • Proptosis
  • Gritty sensation in eyes
  • Lid lag
Abdomen
  • Increased peristaltic movements in patients
Back
Genitourinary
  • Urinary frequency
  • Menstrual irregularities
  • Menstrual irregularities
CNS
Extremities

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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