Hypothyroidism and Hyperthyroidism - Symptoms and Signs
Hypothyroidism:
 - General - From asymptomatic to myxedema coma, “Like everything is slowed down” 
     • Low exercise tolerance 
     • Hyperlipidemia 
     • Cold intolerance
     • Weight gain (modest)  
 - Neuro
     • Depression 
     • Memory loss 
     • Fatigue
 - Face/Neck 
     • Hair is coarse, brittle and is lost 
     • Thinning of lateral 1/3 of eye brows 
     • Puffy Face 
     • Enlarged tongue  
     • Hoarseness 
     • ± Goitre
 - Cardiovascular
     • bradycardia
      • cardiomegaly
      • pericardial effusion 
      • hypertension
 - GI 
     • Constipation
 - Gu: 
     • Menorrhagia
 - Skin 
     • Skin is dry, coarse, thick, cold, pale 
 - Muscles 
     • Weakness, cramps
     • Tendon Reflex Delay (relaxation phase) 
Hyperthyroidism:
 - General “Like running a marathon all the time” 
     • Appear to have high energy but are fatigued  
     • poor exercise tolerance 
     • Heat intolerance 
     • Weight loss (despite appetite) 
 - Neuro:
     • Nervousness 
     • Restlessness 
     • Insomnia 
     • Tremour
     • Increased Reflexes
 - Face/Neck 
     • ophthalmopathy
        ocular changes (periorbital swelling, lid retraction and lid lag, stare and infrequent blinking)  
        infiltrative (proptosis/exophthalmos,  increased edema of lids and conjunctiva, chemosis, ophthalmoplegia) 
     • ± Diffuse goitre
     • Bruit (when osculating over thyroid) 
 - Cardiovascular 
     • Palpitations, Afib
 - GI 
     • Diarrhea
 - Gu: 
     • Infertility, amenorrhea
 - Skin
     • Sweating 
     • Warm, moist skin 
     • Dermatopathy
        Ø Hands: Acropachy
        Ø Legs: “pretibial myxedema

- Amy Chung, MD, MSc @AmyChung 

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