Toxic multinodular goiter physical examination

The clinical features of toxic multinodular goiter includes flushing, diaphoresis, smooth skin, onycholysis, hyperpigmentation, thinning of the hair, thyromegaly,lymphadenopathy, lid lag, shortness of breath on exertion, hypoxemia, hypercapnia, tachycardia, atrial fibrillation, weight loss, increased appetite, anorexia, dysphagia, increased urinary frequency, enuresis, gynecomastia, reduced libido, erectile dysfunction, psychosis, agitation, and depression, anxiety, restlessness, irritability, and emotional lability. Some other features which may be seen are insomnia, confusion, poor orientation and immediate recall, amnesia, and constructional difficulties, peripheral neuropathy, carpal tunnel syndrome, tremors.

Physical examination is as follows:^{[1][2][3][3][4][5][6][7][3][4][5][8]}

• Patients with thyroid adenoma are usually well-appearing.

• Flushing
• Diaphoresis
• Smooth skin
• Onycholysis and nail softening
• Hyperpigmentation
• Thinning of the hair

• Thyromegaly with solitary, non-tender thyroid nodules.
• Soft, smooth, and mobile nodules.
• Lymphadenopathy

• Lid lag occurs in all patients with hyperthyroidism due to sympathetic overactivity.

• Shortness of breath on exertion
• Hypoxemia
• Hypercapnia
• Tracheal compression from a large goiter.
• Pulmonary hypertension.

• Tachycardia with wide pulse pressure.
• Systolic hypertension
• Congestive heart failure
• Dilated cardiomyopathy
• Atrial fibrillation

• Weight loss
• Increased appetite
• Anorexia in older hyperthyroid patients.
• Dysphagia

• Increased urinary frequency and nocturia
• Enuresis is common in children.
• Gynecomastia
• Reduced libido
• Erectile dysfunction.

• Psychosis, agitation, and depression.
• Anxiety, restlessness, irritability, and emotional lability.
• Insomnia
• Cognitive impairments such as confusion, poor orientation and immediate recall, amnesia, and constructional difficulties.
• Peripheral neuropathy
• Carpal tunnel syndrome

• High and low frequency amplitude tremors which can involve the face and head as well as the extremities.
• Myopathy 
• Muscle weakness with or without atrophy and myalgias.
• Proximal and distal weakness.
• Deep tendon reflexes are usually normal or increased,
• Paresthesias, due to coexisting polyneuropathy

• Osteoporosis and an increased fracture

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