What are the common physical findings in Graves disease?

Updated: Apr 17, 2020
  • Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Common physical findings, organized by anatomic region, are as follows:

  • General - Increased basal metabolic rate, weight loss despite increase or similar appetite

  • Skin - Warm, most, fine skin; increased sweating; fine hair; vitiligo; alopecia; pretibial myxedema

  • Head, eyes, ears, nose, and throat - Chemosis, conjunctival irritation, widening of the palpebral fissures, lid lag, lid retraction, proptosis, impairment of extraocular motion, visual loss in severe optic nerve involvement, periorbital edema

  • Neck - Upon careful examination, the thyroid gland generally is diffusely enlarged and smooth; a well-delineated pyramidal lobe may be appreciated upon careful palpation; thyroid bruits and, rarely, thrills may be appreciated; thyroid nodules may be palpable.

  • Chest - Gynecomastia; tachypnea; tachycardia; murmur; hyperdynamic precordium; S3, S4 heart sounds; ectopic beats; irregular heart rate and rhythm

  • Abdomen - Hyperactive bowel sound

  • Extremities - Edema, acropachy, onycholysis

  • Neurologic - Hand tremor (fine and usually bilateral), hyperactive deep tendon reflexes

  • Musculoskeletal - Kyphosis, lordosis, loss of height, proximal muscle weakness, hypokalemic periodic paralysis in persons of susceptible ethnic groups

  • Psychiatric - Restlessness, anxiety, irritability, insomnia, depression

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