Hyperthyroidism

General

Psychiatric

Lethargy, tiredness Dry skin Husky voice

Depression

Dementia

Psychosis

(myxoedema madness)

Myofibrositis Musculoskeletal Myalgia

Joint effusions

Weakness

Sweaty skin, especially hands

Anxiety/irritability

Hyperkinesis

Psychosis

Muscle weakness Proximal myopathy

Skin

Cardiovascular

Endocrine

Gynaecological

Neurological

Dry cool skin Vitiligo

Ischaemia Cardiomegaly Pericardial effusion Bradycardia Hyperlipidaemia

Galactorrhoea

Goitre

Infertility

Menstrual irregularity Menorrhagia (mainly) Oligomenorrhea

Neuropathy

Nerve entrapment e.g. carpal tunnel

Ataxia

Haematological Anaemia Emergency

Myxoedema coma Postanaesthetic hypoventilation

Other

Reduced libido Weight gain Cold intolerance

Warm, thin, soft, moist skin Vitiligo

Pretibial myxoedema

Tachycardia Atrial fibrillation Heart failure Systolic hypertension

Goitre

Gynaecomastia

Oligomenorrhea

Periodic paralysis Tremor

Thyroid crisis

Reduced libido Eye signs Fever (uncommon) Premature grey hair Weight loss

Hashimoto's disease (autoimmune thyroiditis)

Hashimoto's disease, which is an autoimmune thyroiditis, is the commonest cause of bilateral non-thyrotoxic goitre in Australia. Features are:

• bilateral goitre

• classically described as firm and rubbery

• patients may be hypothyroid or euthyroid

Diagnosis is confirmed by a strongly positive antithyroid microsomal antibody titre and/or fine needle aspiration cytology. 3

Hashimoto's disease may present as postpartum hypothyroidism. The hypothyroidism may resolve in 6-12 months or may be permanent. 3

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