Thyroid Disease

Excerpt

Patients with abnormalities of thyroid gland function or structure come to medical attention for several reasons. They present with symptoms attributable to physiologic effects of increased or decreased plasma concentrations of thyroid hormone (hyperthyroidism or hypothyroidism, respectively). They may also present with symptoms related to localized or generalized enlargement of the gland (diffuse goiter, multinodular goiter, or single thyroid nodule). These changes may result from functional abnormalities or neoplasia, benign or malignant.

The following symptoms are typical problems that may eventually be diagnosed as specific thyroid diseases or syndromes. For diagnoses related to hyperthyroidism (thyrotoxicosis), these complaints may include weight loss, anxiety or nervousness, increased sweating, tremulousness, diarrhea, palpitations, muscular weakness, heat intolerance, or history of treatment of an "overactive" thyroid. For diagnoses related to hypothyroidism, typical problems include fatigue, weight gain, depression, lethargy, dry skin, cold intolerance, voice change, change in menses, muscle cramps, or treatment of a thyroid condition. Thyroid enlargement (goiter) may present in the context of hyper- or hypothyroidism. It may also occur in a patient with normal thyroid hormone production (euthyroid patient). Typical complaints related to thyroid enlargement include generalized neck swelling (diffuse goiter), neck mass (uninodular or multinodular goiter), dysphagia, neck pain, or hoarseness. Finally, patients may be referred with no complaints but with "abnormal thyroid function tests" that lead to a search for symptoms and signs of thyroid dysfunction.

Thyroid storm refers to an increasingly rare but still highly dangerous form of thyrotoxicosis that, in addition to the other complaints of hyperthyroidism, is marked by extreme temperature elevation and/or change in mental status, ranging from extreme agitation to coma. Hypothyroid crisis refers to advanced thyroid hormone deficiency manifested by hypothermia and obtundation.