Approach
- Symptoms from the swelling
- Duration and change in size - suddenly increased (haemorrhage into necrotic nodule, subacute thyroiditis, rapidly growing carcinoma)
- Cosmetic symptoms
- Discomfort during swallowing/dysphagia - oesophageal compression
- Dyspnoea (tracheal compression)
- Hoarseness - recurrent laryngeal nerve paralysis secondary to malignant infiltration
- Pain
- Thyroid status
Hyperthyroidism Hypothyroidism General Increased appetite, loss of weight Decreased appetite, weight gain, lethargy Thermogregulatory Preference for cold weather Preference for hot weather Dermatological Increased sweating Dry skin, "peaches and cream" complexion, Musculoskeletal Proximal myopathy (autoimmune) with wasting and weakness Muscle fatigue Gastrointestinal Change in bowel habit - diarrhoea, frequent defecation Constipation Cardiovascular Tachycardia, atrial fibrillation Bradycardia Gynaecological Oligomenorrhoea, amenorrhoea Menorrhagia Psychiatric Nervousness, easy irritability, emotional lability, insomnia, psychosis Slow thought, speech, action, depression, dementia Neurological Fine tremor Symptoms of carpal tunnel syndrome - Other associated symptoms
- Eye symptoms - protruding / staring eyes, difficulty closing eyelids, double vision (secondary to ophthalmoplegia) and pain in eye (secondary to corneal ulceration)
- Relevant medical history
- Previous operations on thyroid gland
- Medications - antithyroid drugs, thyroxine, iodine-containing medications
- Radioiodine therapy for previous Grave's disease
- Fitness for surgery