00:01
Okay, let's review some
of what we've learned.
00:04
For the thyroid exam,
in particular,
we're looking for
some of those findings
that go along with
hyperthyroidism causes
and then
hypothyroidism causes.
00:12
So just honing in
on a few particular boxes
in this chart
with graves disease,
which of course has its own
unique features independent
of the increased sympathetic tone
that accompanies hyperthyroidism.
00:24
You might be looking for a diffuse
enlargement of the thyroid,
though it may be soft in texture,
and of course, your lab values would
have a low TSH and a high T4.
00:33
We'd be looking for exophthalmos
in terms of the eye exam
and potentially pretibial myxedema
down in the legs.
00:40
In contrast,
with hashimoto's thyroiditis
which is the most common
cause of hypothyroidism,
in adults,
men and women,
the size of the thyroid
can be variable,
but the texture
should be more of a firm type
with some fibrotic
changes happening
due to the chronic lymphocytic
infiltration of the thyroid.
01:00
You can see the lab values there
would be the opposite
of what we saw
with hyperthyroidism.
01:05
And some of those classic
manifestations of hypothyroidism
that we've talked about
with bradycardia
and hung reflexes, for example.
01:13
And multinodular goiter may have no
changes to the lab values at all,
but you'd have a slightly
enlarged thyroid gland
with potentially palpable nodules
one or many in number.
01:29
So which of the following
might be seen with hypothyroidism?
Smooth sweaty skin,
Delayed relaxation phase
of the deep tendon reflexes
Lid lag,
pretibial myxedema,
or Exophthalmos.
01:48
So with hypothyroidism we have
decreased sympathetic tone.
01:52
So actually less sweating.
01:54
So smooth sweaty skin would
not be something we would see
with hypothyroidism.
01:59
In contrast,
delayed relaxation phase
of deep tendon reflexes,
so called hung reflexes
is a characteristic feature
of hypothyroidism.
02:07
Lid lag is something we see
with the increased sympathetic tone
of hyperthyroidism.
02:11
Pretibial myxedema is typically
seen with graves disease
because of that
mucopolysaccharide deposition
in the pretibial
regions of the shins
and the exophthalmos
also is part of graves disease
with that polysaccharide
deposition in the ocular muscles
that are pushing
the eyeballs forward.