Graves’ Disease: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing) of skin, eyes, and entire body [wg.
      • Alopecia (hair loss, diffuse).
      • Sweating, warm and humid skin
      • Eyes: exophthalmos (synonyms: ophthalmoptosis; ophthalmopathy; protrusio bulbi; popularly known as “googly eyes”) – pathological protrusion of the eyeball from the orbit (orbit) [occurrence: before, during or after the onset of hyperthyroidism]; redness of the conjunctiva (conjunctiva); incomplete closure of the eyelids (lagophthalmos); foreign body sensation in the eyes and increased lacrimation. Ocular signs of Graves’ hyperthyroidism:
        • Graefe’s sign: When the gaze is lowered, the upper eyelid remains behind, so that the part of the sclera visible above the cornea is enlarged in exophthalmos
        • Stellwag sign: infrequent blinking of the eyelid
        • Dalrymple sign: As a result of upper eyelid retraction (pulling back the upper eyelid), the sclera between the lower edge of the upper eyelid and the limbus corneae (transition zone between the cornea and the sclera of the eyeball) becomes visible as a fine white stripe when looking straight ahead.
      • Palmar erythema – red coloration of the palms.
      • Gynecomastia – enlargement of the mammary gland in men.
      • Dermopathy – skin changes similar to orange peel skin, mostly on the lower legs.
      • Pretibial (anterior to the tibia) myxedema – skin (including subcutaneous and adipose tissue) is typically doughy swollen, cool, dry and rough (especially on the extremities and face); patients look puffy.
      • Acropachy – Bone thickening (due to subperiosteal bone apposition) with concomitant soft tissue thickening (painless; normal temperature) on the finger and toe end links (I-III) and onycholysis (nail plate detachment).
      • Tremor (shaking)]
    • Inspection and palpation (palpation) of the thyroid gland and cervical lymph nodes.
    • Auscultation (listening) of the heart [due topossible sequelae: Tachycardia (too fast heartbeat: > 100 beats per minute), atrial fibrillation]
  • Ophthalmological examination [due topossible sequelae: Corneal damage due to dehydration in the absence/incomplete closure of the eyelid (lagophthalmos), optic nerve compression (high pressure on the optic nerve, which can lead to visual impairment or blindness, as well as color vision impairment)].
    • Perimetry (visual field measurement)
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.