Postpartum thyroiditis physical examination: Difference between revisions

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===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*Low-grade fever in hyperthyroid phase.
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse in hyperthyroid phase.
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse in hypothyroid phase.
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea in hyperthyroid phase.
*Tachypnea / bradypnea
*High blood pressure with normal pulse pressure hyperthyroid phase.
*Kussmal respirations may be present in _____ (advanced disease state)
*Low blood pressure with normal pulse pressure hypothyroid phase.
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
*[[Cyanosis]]
'''Hyperthyroid phase''':
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths="150px">
Sweating increased.


UploadedImage-01.jpg | Description {{dermref}}
Onycholysis.
UploadedImage-02.jpg | Description {{dermref}}


</gallery>
Hyperpigmentation
 
Pruritus and hives.
 
Vitiligo and alopecia areata.
 
Thinning of the hair
 
Peritibail myxedoma in co-existing Grave's disease
 
'''Hypothyroid phase''':
 
Sweating decreased.
 
Dry skin
 
Hair coarse and brttile.
 
Brittle nails.
 
Nonpitting edema


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
'''Hyperthyroid phase''':
* Evidence of trauma
 
* Icteric sclera
Stare and lid lag
* [[Nystagmus]]
 
* Extra-ocular movements may be abnormal
proptosis
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
 
*Ophthalmoscopic exam may be abnormal with findings of ___
Gritty sensation in eyes
* Hearing acuity may be reduced
 
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
'''Hypothyroid phase''':
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
 
* [[Exudate]] from the ear canal
Icteric sclera
* Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
 
*Inflamed nares / congested nares
Pallor
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
*[[Jugular venous distension]]
*Painless [[Thyromegaly]].
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
* Decreased chest expansion due to respiratory muscles fatigue
*Lungs are hypo/hyperresonant
*Distant breath sounds in presence of plural effusion.
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Enspiratory wheezing with delayed expiratory phase in patient due to exacerbation of asthma
*Rhonchi
*Reduced [[tactile fremitus]] in presence of plural effusion.
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
*Chest tenderness upon palpation
*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.
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal distention]] in patients with constipation
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant  
*[[Abdominal tenderness]] in the right upper abdominal quadrant with autoimmune hepatitis.
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
*Dull note on percussion in peritoneal effusion.
*Increased peristaltic movements in patients with hyperthyroid phase.


===Back===
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Point tenderness over lumber vertebrae in osteoporosis in hypo/hyperthyroid phase.
*Sacral edema
*Costovertebral angle tenderness bilaterally osteoporosis in hypo/hyperthyroid phase.
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Urinary frequency are common in hyperthyroidism phase.
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===

Revision as of 19:25, 1 October 2017

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

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.

Appearance of the Patient

  • Patients with PPT usually appear tired or irritable depend of the phase of disease.

Vital Signs

  • Low-grade fever in hyperthyroid phase.
  • Tachycardia with regular pulse in hyperthyroid phase.
  • Bradycardia with regular pulse in hypothyroid phase.
  • Tachypnea in hyperthyroid phase.
  • High blood pressure with normal pulse pressure hyperthyroid phase.
  • Low blood pressure with normal pulse pressure hypothyroid phase.

Skin

Hyperthyroid phase:

Sweating increased.

Onycholysis.

Hyperpigmentation

Pruritus and hives.

Vitiligo and alopecia areata.

Thinning of the hair

Peritibail myxedoma in co-existing Grave's disease

Hypothyroid phase:

Sweating decreased.

Dry skin

Hair coarse and brttile.

Brittle nails.

Nonpitting edema

HEENT

Hyperthyroid phase:

Stare and lid lag

proptosis

Gritty sensation in eyes

Hypothyroid phase:

Icteric sclera

Pallor

Neck

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

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.

Neuromuscular

  • Patient is usually oriented to persons, place, and time
  • Altered mental status
  • Glasgow coma scale is ___ / 15
  • Clonus may be present
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
  • 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

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