Hypothyroidism (Underactive Thyroid): Examination

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

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further:
    • Inspection (viewing) of skin, mucous membranes, and sclerae (white part of eye) [pasty, cool-dry skin especially on face and hands and feet; lackluster shaggy hair; myxedema: Skin is pasty (“bloated”) while showing non-push-in edema (swelling) that is not positional; peripheral edema – swelling of legs due to water retention; alopecia diffusa (diffuse hair loss); anemia (anemia);in children with congenital hypothyroidism: Icterus neonatorum prolongatus – yellowing of the skin, normal in infants but prolonged here, enlarged tongue; retarded growth with dysproportionate short stature, slowed facial maturation (coarsened facial features); myxedema – the skin (inc. subcutaneous and adipose tissue) is doughy swollen, cool, dry and rough, especially on the extremities and face; patients look puffy]
    • Inspection and palpation (palpation) of the thyroid gland [goiter (thyroid enlargement)]
    • Auscultation (listening) of the heart [bradycardia (heartbeat too slow: < 60 beats per minute) [HMV ↓, cyanosis]; hypertension (high blood pressure); right, left ventricular dilatation (permanent expansion of the ventricle) with possible hydropericardium/accumulation of serous fluid in the pericardium [ECG: low voltage of P and T waves and QRS complex]]
    • Examination of the lungs (due topossible sequelae):
      • Auscultation of the lungs [dyspnea (shortness of breath); hypoventilation (restricted pulmonary ventilation) and respiratory insufficiency/disruption of external (mechanical) breathing denoted, resulting in inadequate ventilation of the alveoli (myxedema coma; hypothyroid coma)]
    • Palpation of the abdomen (belly), etc. [in children with congenital hypothyroidism: umbilical herniaI]
  • Ophthalmological examination – in children with congenital hypothyroidism: strabismus (squint).
  • ENT medical examination – in children with congenital hypothyroidism: sensorineural hearing loss.
  • Neurological examination – due topossible hyporeflexia (decreased intensity of one or more reflexes), muscle cramps, stiffness, paresthesias (insensations), cerebellar ataxia (disorders of coordination of movements (ataxia) caused by pathological changes in the cerebellum); in children with congenital hypothyroidism: lack of movement, muscle hypotonia, spastic gait.
  • Health check

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