Postpartum Thyroiditis: Not Just a Worn Out Mom

Katherine Pereira; Ann J. Brown

Disclosures

Journal for Nurse Practitioners. 2008;4(3):175-182. 

In This Article

Physical Findings

Physical exam may vary depending on when in the course of PPT the patient presents. Typical physical findings for hyperthyroidism and hypothyroidism are reviewed in Table 3 . Physical findings that are the result of long-standing hyper-or hypothyroidism are not usually evident in PPT, as this is a relatively transient condition. Thus, one would not expect to find ophthalmic pathology, coarse hair, alopecia, and heart failure in women with PPT.

Physical findings in hypothyroidism of short duration, such as seen with PPT, may be absent or subtle. Classic exam findings of hypothyroidism (particularly of long duration) include a general appearance of facial edema and periorbital edema. Skin is cool or cold to the touch, related to decreased peripheral blood flow. Hair may be coarse or dry; hair loss may be noted on the scalp. The thyroid gland may be variable, depending on thyroid pathology. Exam may show a diffusely symmetrically enlarged gland, but the gland can also be nonpalpable. Peripheral edema can be present. Hyperkeratosis can give the skin a rough, dry, flaky appearance. Deep tendon reflexes will have a delayed relaxation phase. Muscle movements can be slow and clumsy, with some muscle weakness. Carpal tunnel syndrome (compression of the median nerve within the carpal tunnel of the wrist) is more common in patients with hypothyroidism. If patients complain of numbness or tingling in the hands (worse at night), physical exam should assess for diminished sensation in the first three fingers of the hand, and a Hoffman-Tinel test (tapping on wrist over median nerve) and the Phalen maneuver (compression of median nerve) should be performed.

Cardiovascular exam can show bradycardia. Hoarseness from vocal chord thickening can be present, along with chronic nasal congestion related to edema of nasal mucosa. Gastrointestinal exam can reveal hypoactive bowel sounds as evidence of decreased gastric motility.[19] Again, these will be more common in long-standing hypothyroidism and might be absent in PPT.

Physical findings of hyperthyroidism include a warm, velvety moist texture to the skin. Hyperhidrosis may also be present. Nails can become soft and separate from the nail bed (onycholysis). Lid retraction and lid lag give the patients' eyes a prominent appearance and can also be accompanied by signs of conjunctival irritation. Limitation of upward gaze (a manifestation of opthalmoplegia) is also seen. The thyroid gland may be diffusely enlarged, although absence of an enlarged gland does not rule out the possibility of hyperthyroidism. Atrial fibrillation can accompany hyperthyroidism, along with a prominent apical impulse, accentuated heart sounds, and systolic ejection murmur. Heart failure is more likely to occur in older individuals with hyperthyroidism. Coronary artery disease and associated symptoms can also be worsened by hyperthyroidism. Vital capacity can be decreased in hyperthyroidism, and there can be shortness of breath with physical activity, mostly related to respiratory muscle weakness, and less often to cardiac dysfunction such as heart failure.

Gastrointestinal exam can reveal increased gastric motility and hyperactive bowel sounds. Tremor can be present, usually in the hands and fingers, and is most noticeable when hands are extended. Proximal muscle weakness can be evidenced by difficulty rising from a squat or reaching above the head. Deep tendon reflexes are hyperactive and show accelerated contraction and relaxation phases.[19]

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