The examination of someone with suspected hyperthyroidism involves checking the pulse, which may be racing and irregular, blood pressure, which may be high, and reflexes, which may be very quick, using a reflex hammer. In addition, the physician will look for signs of shaking of the hands (a tremor) and any excess sweatiness of the skin.
An examination of the thyroid will be performed by the physician, who places her/his fingers on the neck below the voice box and gently presses inward to locate the gland. Having the patient take a sip of water may make it easier for the physician to locate the gland since it moves up and down with swallowing. The thyroid gland is normally thin and small and may be difficult to feel unless it is enlarged. In Graves’ disease, the thyroid gland is usually enlarged; an enlarged thyroid gland is called a goiter. If nodules are present, the thyroid gland may feel lumpy. In viral (subacute) thyroiditis, the thyroid may be extremely tender. The physician may also place a stethescope over the thyroid to try and hear if there is extra blood rushing through the gland. This occurs in a few patients with Graves’ disease with very overactive thyroid glands.
In elderly individuals, the physician may also examine the heart and lungs for any sign of heart failure or other problems.
Some patients with Graves’ disease will develop eye problems. This occurs only in this form of hyperthyroidism and is called Graves’ ophthalmopathy. In this condition, the eyes may bulge forward because the muscles behind the eye that cause it to move become swollen and push the eyeball forward. When the muscles are damaged, this can result in double vision. Luckily, this severe muscle involvement happens in only a small number of patients with Graves’ disease. Such patients should see an ophthalmologist.
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