Clinicopathologic Correlations

Thyroid Factor

The Natural Thyroid Diet

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Although iodine deficiency is still a worldwide cause of thyroid enlargement, other important causes of goiter are infection, autoimmune disease, cancer, and isolated nodules. An enlarged thyroid may be associated with hyperthyroidism, hypothyroidism, or a simple or multinodular goiter of normal function.

As mentioned earlier in this chapter, the thyroid may enlarge and expand into the chest cavity. If the thyroid is large enough, it may impair venous outflow from the head and neck and may even be responsible for airway or vascular compromise. Pemberton's sign is a useful maneuver for detecting latent obstruction in the thoracic inlet. To determine whether the sign is present, the patient is asked to elevate both arms until they touch the sides of the head. Facial suffusion with dilatation of the cervical veins that develops within a few seconds is Pemberton's sign, which means the test result is positive. After 1 to 2 minutes, the face may even become cyanotic. Figure 9-14 shows a patient with a positive Pemberton's sign. The patient is a 62-year-old man with an anterior neck mass, the existence of which was known for 25 years. The upper border of the thyroid was palpable on examination, but the lower pole descended below the clavicle and was not palpable.

As indicated in the quotation at the beginning of this chapter, hyperthyroidism may manifest with a variety of generalized symptoms and signs. It has been said, ''To know thyroid disease is to know medicine,'' because there are so many generalized effects of thyroid hormone excess. Table 9-1 lists the variety of clinical symptoms related to thyroid hormone excess.

A nervous, perspiring patient with a stare and bulging eyes offers an unmistakable combination of physical signs associated with hyperthyroidism. The most common type of hyper-thyroidism is the diffuse toxic goiter, known as Graves' disease. Symptomatic Graves' disease has an incidence of 1 per 1000 women in multinational studies. This disease can occur at any

*Refers to two separate murmurs, systolic and diastolic.

Superior Vena Cava Thrombosis
Figure 9-14 A and B, Pemberton's sign.

Table 9-1 Symptoms of Hyperthyroidism

Organ System Symptom

General Preference for the cold

Weight loss with good appetite

Eyes Prominence of eyeballs*

Puffiness of eyelids Double vision Decreased motility

Neck Goiter

Cardiac Palpitations

Peripheral edema{

Gastrointestinal Increased numbers of bowel movements

Genitourinary Polyuria

Decreased fertility

Neuromuscular Fatigue

Weakness Tremulousness

Emotional Nervousness

Irritability

Dermatologic Hair thinning

Increased perspiration Change in skin texture Change in pigmentation

•Appears to result from mucopolysaccharide deposition behind the orbit.

{Appears to result from excessive mucopolysaccharide deposition under the skin, especially in the legs.

Figure 9-15 Graves' disease: unilateral proptosis.

Figure 9-15 Graves' disease: unilateral proptosis.

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