Paediatric-History taking & Physical examination of Hyperthyroidism

Paediatric-History taking & Physical examination of HyperthyroidismCreated OnApril 29, 2020Last Updated OnApril 29, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of Hyperthyroidism < All Topics Table of Contents History taking: Ask about patient’s details: Name, age, gender Age Infant: neonatal Graves’ disease Depends if mother is taking antithyroid drugs If didn’t take: hyperthyroid at birth If took: hyperthyroid after drug metabolizes (~3-7 days) 11 – 15yo: Graves’ disease Gender Graves’ disease: 5x more common in females Neonatal Graves: affects males and females equally Ask about chief complaint & relevant history of presenting illness Symptoms of hyperthyroidism Onset? Duration? Weight loss despite increased appetite Palpitations, shortness of breath Tremor Heat intolerance, increased sweating Increased frequency of bowel movements Menstrual abnormalities: oligomenorrhea, amenorrhea Irritability, anxiety, poor concentration Restless sleep Symptoms of Graves’ disease Neck swelling How and when it was first noticed? Site Size Shape Skin changes – Redness? Discharge? Blood? Rate of increment in size – if swelling enlarges rapidly over a short period of time, suspect malignancy Pressure symptoms: dyspnea, hoarseness of voice, dysphagia Eye Proptosis Gritty feeling or pain in eyes, increased lacrimation Diplopia (due to extraocular muscle dysfunction) Skin Onycholysis (loosening of nails from nail bed) Softening of nails Thinning of hair Pretibial myxedema (rare in children) Thyroid acropachy (rare in children) Recent URTI, sudden onset of painful goiter (suggestive of subacute thyroiditis) Ask about past medical history Conditions associated with Graves’ disease T1DM Pernicious anemia Alopecia areata Vitiligo Myasthenia gravis History of radiation therapy to head and neck region Ask about drug history Recent use of iodine-containing compound – amiodarone, iodoquinol Ask about antenatal history Does mother have Graves’ disease, if yes When was it diagnosed? Treatment – type, dosage, compliance Control of disease, follow up USG measurements of fetal thyroid size History of fetal tachycardia, IUGR Any prenatal testing done Maternal serum thyrotropin receptor Ab level at 3rd trimester Ask about birth history Mode of delivery Birth weight (low) Prematurity Features of neonatal Graves’ disease Microcephaly Frontal bossing & triangular facies Warm, moist skin Diffuse goiter Stare, occasional exophthalmos Irritable, restless and poor sleep Hyperphagia, increased bowel movements Ask about developmental history May have developmental delay Ask about feeding history Increased appetite Iodine deficient diet Ask about family history Family history of Graves’ disease or thyroid diseases Family history of autoimmune diseases Physical examination: General Vital signs Pulse: resting tachycardia, bounding, atrial fibrillation BP: Systolic hypertension, wide pulse pressure Temp: elevated in subacute thyroiditis Respiratory rate: increased Thin build, proximal muscle weakness, sweating Anxious, irritable Warm, moist palms Thyroid acropachy Fine tremor on outstretched hands Thyroid dermopathy: pretibial myxedema Eye examination Chemosis Exposure keratitis Lid lag (von Graefe sign) – retarded descent of upper lid on downward gaze → hold your finger high and ask the child to follow as you move your finger downwards, whilst keeping his/her head still Lid retraction (Kocher sign) – staring & frightened appearance of the eyes Exophthalmos à inspect from above Stellwag’s sign: infrequent and incomplete blinking Dalrymple’s sign: upper sclera is visible due to upper lid retraction Joffroy’s sign: absence of creases on forehead on upward gaze Mobius sign: difficulty to converge eyeballs Gifford’s sign: difficulty in eversion of upper eyelid Ophthalmoplegia (assess for eye movements if the child is able to follow instructions) Examination of neck swelling Inspection: Site, size, shape, surface, skin changes Instruct patient to swallow (thyroid moves with deglutition) Protrude tongue (thyroglossal cyst moves...

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