16 Examining of patient with thyroid and adrenal gland diseases

Main symptoms from the anamnesis

Hyperthyroidism –

 loss of weight
 fever
 tachycardia
 systolic hypertension
 fatigue,
 diarrhea,
 loss of hair
 menstrual disorders
 eventually diabetes etc. symptoms from the thyroid gland, symptoms from the eyes,
eventually symptoms from the pituitary gland in cases with secondary hyperthyroidism;

Hypothyroidism –

 gain of weight
 constant feeling of cold
 Sleepiness
 slowed thinking
 speaking
 lack of concentration
 constipation
 loss of hair
 edema
 fatigue,
 menstrual disorders,
 tremor,
 photophobia,

Predisposition and provoking factors – family history, endemic region, stress, toxicity (drugs –
amiodaron), infections;

Physical examining of patient with hyperthyroidism

 General inspection – reduced bodyweight, increased moisture of the skin, tremor, possibly
pretibial edema, etc.
 Head and neck – exophthalmos, eventually lagophthalmos, staring and shining eyes, positive
enlarged thyroid gland;
 Heart – tachycardia, possibly rhythm disorders, systolic hypertension;
 Abdomen – possibly slightly enlarged liver;

Physical examining of patient with hypothyroidism

 General inspection – increased bodyweight, dry skin, possibly pretibial edema;

  Head and neck – dull expression of the face, coarse voice, loss of hair, possibly enlarged
thyroid gland;
 Heart – bradycardia, possibly signs of pericarditis;
 Abdomen possibly enlarged liver;

Main symptoms from the anamnesis of patient with hyperadrenocorticismus (Cushing syndrome
or disease) –

 arterial hypertension
 increased bodyweight
 diabetes
 fatigue
 edema
 menstrual disorder
 loss of hair
 pain in the bones – osteoporosis,
 eventually symptoms of hyperacidity, symptoms from the pituitary gland in patient with
Cushing disease – headache, double vision, etc;

Predisposition and provoking factors – family history, stress, infections;

Main symptoms from the physical examining

 obesity central type with buffalo hump,

 acantosis nigricans,
 pink striae
 edema,
 moon shaped face
 loss of hair
 high blood pressure
 enlarged liver, etc.

Main symptoms from the anamnesis of patient with hypoadrenocorticism –

 fatigue
 weakness
 hypotension
 orthostatism,
 menstrual disorders,
 loss of hair,
 symptom from pituitary gland, etc.
 myalgia

Main symptoms from physical examining of patient with hypoadrenocrticism –

 darkening of skin and visible mucosa – palms, gums, under the tongue, under the breasts
etc.
  hypotension,
 reduced bodyweight,
 loss of hair, etc.

Symptoms from anamnesis and physical examining of patient with pheochromocytoma and
primary hyperaldosteronism (Cohn disease).

 Laboratory tests for thyroid glad diseases

 Ordinary tests – cholesterol, glucose, calcium, blood count, liver enzymes, etc.
 Specific tests – hormones - FT3, FT4. TSH clinical interpretation to distinguish primary from
secondary thyroid gland disease; immunological tests TAT, MAT, - indication; t
 It is advisable to mention the instrumental tests, although they are not included in the
question – ultrasound, scintigraphy, MRI, biopsy;
 Laboratory tests for diseases of the suprarenal glands
 Ordinary tests – glucose, cholesterol, K, Na, blood count, liver enzymes, etc,
 Specific tests – hormones – cortisol rhythm, ACTH rhythm clinical interpretation to
distinguish primary form secondary disease, renin and aldosterone interpretation to
distinguish primary from secondary hyperaldosteronism, catecholamine, 17 keto- and
Hydroxicorticosteroids.
 Functional tests – Dexamethaosn test, Synacten (Cortrozin) tests – clinical interpretation;
 It is advisable to mention the instrumental tests, although they are not included in the
question – CT, MRi, etc,