Table 201 Symptoms related to the endocrine system

Psychogenic changes

• depression

Constitutional symptoms

• tiredness, lethargy

Sexual dysfunction

• menstrual dysfunction, e.g. amenorrhoea

Diabetogenic symptoms

• polyuria/polydipsia

Glycaemia fluctuations

• hypoglycaemia

• hyperglycaemia

Weight changes

Cardiac changes

• heart rate disturbances

• myocardial ischaemia

Skeletal changes

• osteoporosis

Muscle changes

Skin changes

• pigmentation

Blood pressure fluctuations

• postural hypotension

• hypertension

Gastrointestinal

• constipation

Tongue enlargement

• hypothyroidism, myxoedema, acromegaly

Tests for thyroid disorders

Thyroid function tests

Advances in technology have allowed the biochemical assessment of thyroid function to change dramatically in recent years with the introduction of the serum free thyroxine (T4) and the monoclonal TSH assays. With the highly sensitive TSH assays it is now possible to distinguish suppressed TSH levels (as in hyperthyroidism) from low but normal levels of TSH in the euthyroid state. However, the new assays are not foolproof and require interpretation in the context of the clinical picture. The serum TSH is the most sensitive index of thyroid function and is the preferred test for suspected thyroid dysfunction.

Serum tri-iodothyronine (T3) measurement and serum free thyroxine (T4) can be useful in suspected T3 toxicosis where serum T4 may be normal, and for monitoring patients with treated thyroid dysfunction. The relative values are summarised in Table 20.2 .

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