CLINICAL GENERAL FEATURES OF HYPERTHYROIDISM
Clinical general features of hyperthyroidism can be divided into
A-General Examination
As 1-underweight 2-cutaneous changes as profuse sweating flushed face moist warm extremities (palms are warm and sweating contrary to psychoneurotics in whom the hands are
cold and sweating )falling of hairs ,pretibial myxoedema it is thickening of the skin by a mucin - like deposit nearly always associated with true exophthalmos and high levels of TsAb it is usually symmetrical the earliest stage is a shiny red plaque of thickened skin with coarse hair which may be cynaotic when cold in severe case
s the skin of the whole leg below the knee is involved together with that of the foot and ankle and there may be clubbing of the fingers and toes 3- nervous signs as irritability and anxiety fine tremors of the fingers and tongue reflexes are exagerated due to hyper excitability of nerves . myopathy weakness of the proximal limb muscles due to depletion of muscle glycogen 4- cardiovacular signs as 1- pulse -rate tachycardia even during sleep pluse rate always increased to 100-120 beats |minute in sever cases it may reach 140-160 -character of pulse it is big volume (water -hummer of collapsing character) -rhythm all types of arhythmia except heart block as multiple extrasystoles paroxysmal atrial tachycardia and so 2- blood pressure systolic B.P is high but the diastolic is usually low or normal or not much raised due to peripheral vasodilation which increase pulse pressure 3- heart dilatation of both ventricles esp.the right accentuation of heart sounds and functional soft systolic murmur maximum over the pulmonary area 5- eye manifestations 1- certain eye signs like 1- stellwag,s sign :staring and gazing look with infrequent blinking of eye lids normally 5-10 per minute if less than 4 = infrequent blinking 2- von Graefe,s sign lagging of the upper eye lid when the patient is asked to look gradually down without moving the head so that a rim of sclera may be exposed 3- Dalrymple,s sign :when the patient looks straight forwards a rim of sclera can be seen above the cornea 4- Joffroy,s sign lack of corrugation of the forehead when looking up without moving the head due to exophthalmos 5- moebius ,s sign :lack of convergence when look to near object due to muscle paresis
B) Exophthalmos which means is a disorder varying from staring eyes to obviously eyeballs normally the upper eyelid covers about 0ne-sixth of the cornea in exophthalmos the palpebral fissure is widened and the cornea is totally uncovered so that the eyes apear staring or obviously bulging
C) tremores on closed eye lids slightly
Rosenbach,s sign 6- reticulo-endothelial signs as mild -just palpable spleen and generalized lympadenopthy may be present
Clinical general features of hyperthyroidism can be divided into
A-General Examination
As 1-underweight 2-cutaneous changes as profuse sweating flushed face moist warm extremities (palms are warm and sweating contrary to psychoneurotics in whom the hands are
cold and sweating )falling of hairs ,pretibial myxoedema it is thickening of the skin by a mucin - like deposit nearly always associated with true exophthalmos and high levels of TsAb it is usually symmetrical the earliest stage is a shiny red plaque of thickened skin with coarse hair which may be cynaotic when cold in severe case
s the skin of the whole leg below the knee is involved together with that of the foot and ankle and there may be clubbing of the fingers and toes 3- nervous signs as irritability and anxiety fine tremors of the fingers and tongue reflexes are exagerated due to hyper excitability of nerves . myopathy weakness of the proximal limb muscles due to depletion of muscle glycogen 4- cardiovacular signs as 1- pulse -rate tachycardia even during sleep pluse rate always increased to 100-120 beats |minute in sever cases it may reach 140-160 -character of pulse it is big volume (water -hummer of collapsing character) -rhythm all types of arhythmia except heart block as multiple extrasystoles paroxysmal atrial tachycardia and so 2- blood pressure systolic B.P is high but the diastolic is usually low or normal or not much raised due to peripheral vasodilation which increase pulse pressure 3- heart dilatation of both ventricles esp.the right accentuation of heart sounds and functional soft systolic murmur maximum over the pulmonary area 5- eye manifestations 1- certain eye signs like 1- stellwag,s sign :staring and gazing look with infrequent blinking of eye lids normally 5-10 per minute if less than 4 = infrequent blinking 2- von Graefe,s sign lagging of the upper eye lid when the patient is asked to look gradually down without moving the head so that a rim of sclera may be exposed 3- Dalrymple,s sign :when the patient looks straight forwards a rim of sclera can be seen above the cornea 4- Joffroy,s sign lack of corrugation of the forehead when looking up without moving the head due to exophthalmos 5- moebius ,s sign :lack of convergence when look to near object due to muscle paresis
B) Exophthalmos which means is a disorder varying from staring eyes to obviously eyeballs normally the upper eyelid covers about 0ne-sixth of the cornea in exophthalmos the palpebral fissure is widened and the cornea is totally uncovered so that the eyes apear staring or obviously bulging
C) tremores on closed eye lids slightly
Rosenbach,s sign 6- reticulo-endothelial signs as mild -just palpable spleen and generalized lympadenopthy may be present
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