Diagnosing Hyperthyroid

Important physical findings of Graves' disease include:

Features of hyperthyroidism (see above and below)

Diffusely enlarged thyroid gland (with occasionally thyroid bruits and

thrills)
Onycholysis (4th and 5th fingernails) terlepasnya kuku dari matriks
Pretibial myxedematous changes (skin like orange peel)
Acropachy (clubbing jari- jari tangan dan kaki
Ophthalmopathy:
o Found in about a quarter of Grave's disease sufferers
o Widened palpebral fissures
o Proptosis (pergeseran atau penonjolan ke depan)
o Lid lag (keterlambatan kelopak mata dalam mengikuti gerakan
mata)
o Lid retraction
o Ophthalmology assessment recommended

General:

Sweaty
Anxious
Depression
Irritable

Skin:

Warm, moist skin (palms with hand shake)

Fine hair
Vitiligo
Alopecia
Pretibial myxoedema
Onycholysis

Cardiovascular:

Tachycardia
Atrial fibrillation
Left ventricular hypertrophy

Respiratory:

Dyspnoea

Gastrointestinal:

Diarrhoea
More frequent bowel habit

Renal:

Polyuria and polydypsia ( rasa haus yang berlebih ) but no other evident
cause

Neuromuscular:

Tremor
Proximal muscle weakness
Hyperactive tendon reflexes

Skeletal:

Acropachy ( clubbing jari-jari tangan )

Osteoporosis
Raised calcium and alkaline phosphatase

Menstrual/endocrine:

Irregular periods
Gynaecomastia ( perkembangan kelenjar susu yang berlebihan pada lakilaki )

Diagnostic Workup

Graves Disease
Gambaran klinik klasik dari penyakit graves antara lain adalah tri
tunggal hipertitoidisme, goiter difus dan eksoftalmus.
Lab Exam
TSH Test -- usually low to undetectable. (Note: The low end of
the TSH range is controversial. The new, recommended low is
0.3, but many doctors and most labs are still using the
older, outdated bottom range number of 0.5.)
T4/Free T4 Test -- Normal to High
T3/Free T3 Test -- Normal to High
Radioactive Iodine Uptake (RAI-U) -- elevated.

DIFFERENTIAL DIAGNOSIS

Toxic multinodular goiter; Plummer's disease

Symptoms are those of hyperthyroidism. However, the
bulging eyeballs seen in Graves disease do not occur.
Symptoms include:
Fatigue
Frequent bowel movements
Heat intolerance
Increased appetite
Increased sweating
Menstrual irregularities (in women)
Muscle cramps
Nervousness
Restlessness
Weight loss
Exams and Tests
A physical examination will show one or many nodules in
the thyroid. There may be a rapid heart rate.
Other test results:
Serum thyroid hormone levels (T3, T4) are high.
Serum TSH (thyroid stimulating hormone) is low.
Thyroid scan shows that the nodules are taking up
increased amounts of radioactive iodine.

Daftar Pustaka
Lee,
L
Stephanie.
2006.
Hyperthyroidim
http://www.emedicine.com/med/topic1109.htm, last updated: Juli 18, 2006

Corwin. E J, Patofisiologi, Edisi 1, EGC, Jakarta, 2001 : hal 263 265

Harrison, Prinsip-Prinsip Ilmu Penyakit Dalam, alih bahasa Prof.Dr.Ahmad H.
Asdie, Sp.PD-KE, Edisi 13, Vol.5, EGC, Jakarta, 2000 : hal 2144-2151
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