Hashimoto’s Thyroiditis: Examination

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

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin, mucous membranes, and sclerae (white part of eye) [dull shaggy hair, doughy/cool dry skin especially on face and hands and feet, cyanosis (bluish discoloration of skin), alopecia diffusa (diffuse hair loss); Myxedema – pasty (puffy; bloated) skin showing non-push-in, doughy edema (swelling) that is not positional; on the face and peripherally; occurring especially on the lower legs]
    • Inspection and palpation (palpation) of the thyroid gland [differential diagnosis: struma multinodosa]
    • Auscultation (listening) of the heart [bradycardia (too slow heartbeat: < 60 beats per minute), heart failure (differential diagnosis)]
    • Examination of the lungs (due topossible secondary diseases).
      • Auscultation of the lungs
      • Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[in the case of reduced sound conduction (attenuated or absent: for example, in pleural effusion). As a result, the number “66” is barely audible to absent over the diseased portion of the lung because the high-frequency sounds are greatly attenuated]
      • Voice fremitus (checking the transmission of low frequencies; the patient is asked to say the word “99” several times in a low voice, while the doctor puts his hands on the chest or back of the patient)[in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion). As a result, the number “99” is barely audible to absent over the diseased portion of the lung, as the low-frequency sounds are greatly attenuated]
  • If necessary, neurological examination [due topossible sequelae: Dementia, Hashimoto’s encephalopathy (changes in the brain probably related to Hashimoto’s thyroiditis), carpal tunnel syndrome (compression syndrome of the median nerve in the region of the carpus), paresthesias (insensations), cerebellar ataxia (gait disturbance)].
  • Health check

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