DIFFERENTIAL

DIAGNOSIS
For Hyperthyroidism
Hyperthyroidism
• = is a disease of the thyroid gland. Hyperthyroidism results in an
abnormal overactivity of the thyroid gland. The thyroid gland is
located in the front part of the neck, and the thyroid hormone it
produces is vital to normal metabolism. In hyperthyroidism the
thyroid is stimulated to produce too much thyroid hormone.

• A diagnosis of hyperthyroidism may be delayed or missed because

some symptoms, such as nervousness, irritability fatigue, weight
gain, muscle aches and weakness can be ambiguous and/or mild.
These symptoms can be easily attributed to other conditions, such
as excessive coffee drinking, aging, stress, anxiety, excessive
exercise, lack of exercise, perimenopause, cold weather or the side
effects of medications
• Cocaine or amphetamine abuse

• Hyperparathyroidism

• Myasthenia gravis

• Psychological disorders (e.g.,

anxiety, panic attacks, or mood
disorders)

• Widespread thyroid cancer

• Hypertension
Cocaine or amphetamine abuse
• produced from the leaves of the coca plant
• known as stimulants, acting as a dopamine
reuptake inhibitor
• stimulates brain cells, enhancing mood and
movement
• dextroamphetamine, methamphetamine
(speed), and various appetite suppressants
and decongestants
• small amounts (up to 100 mg), the effects may
include feeling energetic and mentally alert
• significant period of time may suffer from
restlessness, extreme excitability, and
insomnia
• Repeated use may lead to a toxic psychosis
characterized by mounting anxiety, paranoia,
and auditory, visual, and tactile hallucinations
• occasional use, physical symptoms and may
include abdominal cramps, nausea, diarrhea,
fever, chills, and exhaustion.
• abrupt cessation of cocaine use will result in
depression, sleep disturbances, sluggishness
(lethargy), muscle aches, and often a
powerful craving for the drug
Physical exam:
• Symptoms of a cocaine overdose
enlarged (dilated) pupils,
constricted blood vessels (causing
pale, cool skin), increased blood
pressure, and increased core body
temperature and heart rate
• In long-term users, rapid breathing,
increased perspiration, and anxiety
• examined for a perforated nasal
septum or decreased sense of smell
(from inhaling cocaine), or needle
marks and abscesses indicating
injection
• marked weight loss may be evident
• A mental status examination may
reveal signs of confusion, paranoia,
hallucinations, impulsivity,
agitation, and hyperactivity
Tests: A polydrug blood or urine screen test can confirm cocaine
use and the approximate amount used, if done within a few
hours of use. Electrocardiogram may reveal disturbances of heart
rhythm.
Hypertension
• caused by other medical conditions, such as
thyroid disease or chronic kidney disease
• may also be a side effect of certain
medication like pills
• Obesity and heredity also play a role in the
development of hypertension
• Dx includes performing complete
evaluation of medical history and physical
examination and a series of blood pressure
readings.
S/S of Hypertension
• No symptoms - many people are unaware they have hypertension
until it is accidentally found at a doctor visit or they develop
complications of hypertension,
• non-specific symptoms - symptoms of hypertension may be mild
and vague, headache, morning headache, tinnitus - ringing or
buzzing in ears, dizziness, confusion, papilloedema,
• many symptoms occur from complications of hypertension,
usually asymptomatic, fatigue, shortness of breath, convulsion,
changes in vision, nausea, vomiting, anxiety, increased sweating,
nose bleeds, heart palpitations, general feeling of unwellness,
increased urination frequency, blurred vision, double vision,
flushed face, pale skin, red skin and chest pains
Hyperparathyroidism
• Hyperparathyroidism is an endocrine disorder in which any of the
four glands located next to the thyroid gland near the front of the
neck (parathyroid) release an excessive amount of parathyroid
hormone
• Risk: found approximately 3 times more common in women and the
risk increases with age; postmenopausal women are at the highest
risk
• Physical exam: may reveal muscle weakness or calcium precipitate
in the tissues due to the hypercalcemia. Abnormal deposits of
calcium (calcinosis) may occur in joints causing a type of arthritic
inflammation known as pseudogout. Eye (ophthalmic) exam may
reveal calcium precipitate in the corneas (band keratopathy).
Enlargement or tumor of the parathyroid gland may be evident
• Tests: Diagnosis of hyperparathyroidism is confirmed by tests to
measure the level of calcium, phosphorus, and parathyroid
hormone in the blood. In about 50% of cases,
• individuals are unaware of the disorder and discover it only
through routine multi-panel blood work that reveals high levels of
calcium and parathyroid hormone, or through urinalysis that shows
high calcium levels.
• A twenty-four hour urine for calcium levels is critical to
differentiate from FHH (familial hypocalciuria and hypocalcemia),
which needs no treatment.X-ray tests may also be used to diagnose
hyperparathyroidism. X-ray films can show evidence of excess
parathyroid hormone action on certain bones. Occasionally, a
routine chest x-ray may reveal a parathyroid mass.
Myasthenia Gravis
• Myasthenia gravis (MG) is a relatively rare autoimmune disorder in
which communication between nerve and muscle is interrupted
• Risk: Women were thought to be more likely to have myasthenia
gravis than men
• History: Myasthenia gravis (MG) is characterized by chronic fatigue
and muscle weakness, especially in the face and throat. The onset
of symptoms is usually gradual, with drooping of the upper eyelids
(ptosis), double vision (diplopia), and weakness of the facial
muscles. The weakness may then extend to other muscles,
particularly the respiratory muscles. Muscular exertion, stress, and
infection may aggravate symptoms, which typically vary over the
course of the
• Physical exam: The exam may reveal
• weak eye closure, drooping eyelids, double vision, slack facial muscles,
and a blank facial expression
• may have difficulty chewing and swallowing. Since the gag reflex is often
absent, there is a risk for inhalation (aspiration) of food, liquid, or saliva
that may cause the individual to choke
• The voice may have a nasal quality. Neck muscles may be too weak to
hold up the head, causing it to fall onto the chest when the individual is
seated
• Weakened respiratory muscles may impair breathing, making the
individual prone to pneumonia and other respiratory infections
• The thymus gland, part of the body's immune system, is abnormally
enlarged in about 75% of individuals with myasthenia gravis, and in about
15% of these cases, a tumor of the thymus gland (thymoma) is found
Thyroid Cancer
• : Individuals with thyroid cancer usually report a single, firm,
nontender lump (nodule) at the base of the neck
• If the tumor is pressing on other structures in the neck, symptoms
may include hoarseness or loss of voice from pressure on nerves in
the vocal chord (larynx) and difficulty swallowing or breathing due
to pressure on the throat (esophagus) or wind pipe (trachea),
respectively
• If the tumor has spread (metastasized), the individual may report
respiratory difficulties, cough, blood in the sputum (hemoptysis),
chest pain, and musculoskeletal problems such as bone pain.
Psychological Disorder
Anxiety disorders can manifest in one's mood, behavior, thoughts,
and emotions
• Symptoms include severe feelings of panic, dread, distress, anxiety,
apprehension, restlessness, and/or trepidation
• include panic disorder and adult panic anxiety syndrome, in which a
person experienced episodes of a crippling sense of terror and
panic called panic attacks
• obsessive compulsive disorder
• also often produce physical symptoms, including an elevation in
heart rate, increased alertness, palpitations, chest pain, and
shortness of breath. Anxiety disorders can seriously affect a
person's ability to function effectively in daily life