Complaints of hyperthyroidism
The majority of patients (70-90%) have a thyroid goiter: The thyroid gland is enlarged; this enlargement, when it has reached a certain size, becomes visible with normal head posture and especially when the head is reclined (=head in the neck). When swallowing, the goiter is mobile, which is an important criterion for distinguishing it from a malignant event in the thyroid gland. The stages of thyroid enlargement are classified according to the following order: Stage Ia: The goiter is palpably enlarged and not visible even with the head reclined.
Stage Ib: The goiter is only visible with the head reclined into the neck. Stage II: The goiter is visible with normal head position. Stage III:In addition to the goiter, congestion of the neck veins occurs, indicating displacement from structures adjacent to the thyroid gland.
Patients are often nervous, easily excitable and angry, emotionally unstable and restless. They notice trembling of their fingers and report sleep disturbances. The heart rate is elevated and there may be extra beats of the heart (=extrasystole) or cardiac arrhythmia, which patients usually report as “heart stumbling”.
Blood pressure is often elevated when the thyroid gland is overactive (hyperthyroidism) (arterial hypertension). Patients suffer from diarrhoea and lose weight, although they have an increased appetite and eat more food. Half of the patients have impaired glucose tolerance, i.e. they have elevated blood sugar levels in an empty state and after meals.
The patients’ skin is warm and moist, they sweat more and tolerate heat only poorly. Hair loss can also be a symptom of hyperthyroidism. Another symptom is the weakness of the thigh muscles, so that many patients feel weak and lacking in drive (=adynamic).
If hyperthyroidism is caused by Graves’ disease, the following additional symptoms may be present: The thyroid gland is enlarged in an inflammatory way, and autoantibodies against the TSH receptor and elevated thyroid hormone concentrations are detectable in the blood. Endocrine orbitopathy exists in the majority of patients: it is defined as the protrusion of one or both eyeballs from the orbit. This is caused by an inflammatory process that affects tissues surrounding the eye (eye muscles, fatty tissue): Cell enlargements in the tissue around the eyeball and in the eye muscles as well as the storage of glycoproteins (=proteins with a sugar residue in the chemical structure) and subsequent water retention cause the orbitopathy.
Patients report double vision, have a rare blinking of the eyelid (=Stellwag sign) and dry eyes, they are afraid of light and have the feeling to have a foreign body in the eye. If the patients look down, the upper eyelid does not lower with them (=Gräfe sign). The patients’ vision (=visibility) decreases.
In addition, twitching eyelids may occur due to overproduction of thyroid hormones. In a small proportion of patients with Graves’ disease, the skin is affected in the form of myxedema on the front edge of the pseudo-subjective bone (= tibia) and the forefoot: Glycoproteins are also stored here, which attract water, so that a thickening of the subcutaneous tissue in front of the tibia occurs. No dents form when pressure is applied to the thickened skin. The finger and foot nails can also be affected: they detach from the nail bed (=oncholysis).
