ENDOCRINOLOGY SYSTEM HISTORY GUIDELINES

SYMPTOM
GENERAL
Fatigue; weakness; weight changes; appetite changes (increased with diabetes, hyperthyroidism)
THYROID
bowel changes (constipation, diarrhoea )
Swelling in neck
Hot/ cold weather preferences
Palpitations
Excessive sweating, sweaty palms, feeling anxious
Voice changes
DIABETES
Polyuria; polydipsia; recurrent infections; poor wound healing; vision changes
Additional:
Hair changes coarser, loss of outer third of eyebrows (hypothyroid). Hirsutism (Androgen excess adrenal,
ovarian, tumours)
Skin changes drier (hypothyroid), pigmentation (adrenal -Addisons disease),
Reproductive: changes in periods (oestrogen, progesterone); milky nipple discharge (prolactin); breast
development in male, difficulties with erection (testosterone, Oestrogen , progesterone)
COMPLETE THE HISTORY
As per usual, especially considering:
Past Medical / Current medical problems:
Consider prior endocrine diseases;
Prior surgery eg thyroid
Medications: thyroid replacement, Hormone replacement;
Social History: especially smoking (risks with diabetes), alcohol,
Social situation
Family History: consider inheritable conditions
Thyroid Gland Examination
From front and side:
Look for masses, scars (esp thyroidectomy scar), prominent veins, signs of inflammation
The thyroid rises with swallowing
Ask patient to take a sip of water & hold it in their mouth until you ask them to
Inspection
swallow so that you can observe
Note any masses which rise with swallowing.
Ask patient to stick out their tongue,
A thyroglossal cyst causing a mid-line mass would rise with this action
Best done from behind with patients neck slightly flexed
(Be aware that the thyroid gland is not always palpable)
To orientate
feel for the V shaped notch of the top of the thyroid cartilage (Adams Apple)
Below is the cricoid cartilage and the first tracheal ring
The isthmus of the thyroid overlies the 2 -4 tracheal rings
nd th

Using finger pads of both hands in the midline just below cricoid cartilage
Palpation
feel for the isthmus
Move fingers 1-2cm laterally (under the sternocleidomastoids)
Palpate one lateral lobe at a time
use the fingers of one hand to steady one lobe while the fingers of the other hand
palpate the opposite lobe
Note size, shape, consistency, mobility, and the presence of tenderness or thrill
Repeat the assessment with patient swallowing
Auscultation Listen over each lobe for a bruit
Distended neck veins
Presence of stridor
Look for Dullness to percussion over manubrium
signs of Pembertons sign
retrosternal Ask patient to lift both arms in the air
goitre Look for plethora / cyanosis in face, distended neck veins & stridor / respiratory
distress
Indicative of thoracic obstruction from a retrosternal goitre
Thank patient.
Additional clinical notes

Peripheral Signs of over active thyroid

Facies - anxious / agitated
General Inspection Body habitus evidence of weight loss
Is clothing appropriate for ambient temperature or weather?
Warm & sweaty
Onycholysis
Nails and hands Acropachy (appearance similar to clubbing- Graves disease only)
Palmar erythema
Tremor (ask pt to hold out arms, place sheet of paper over hands to detect tremor)
Radial pulse Tachycardia (+/- AF, may have collapsing quality)
Exophthalmos/ Lid retraction / Lid lag
Eye signs a/w
Chemosis: Conjunctiva swelling and redness
Graves Disease
Opthalmoplegia: Test external eye movements if exophthalmos present
Legs Pretibial Myxoedema (Graves disease only)

MSK Proximal myopathy

Neurological Brisk reflexes

Peripheral Signs of under active thyroid

Facies - apathy/ listlessness
Skin- pale with yellowish tint, +/- malar flush

General Inspection Body habitus high BMI

Is clothing appropriate for ambient temperature or weather?
Mental state- slowed thought processes and speech
Peri orbital oedema
Bilateral ptosis,
Face and Mouth
Loss of outer third of eyebrows
Enlargement of tongue
Hands Cool & dry
Radial pulse Bradycardia
Skin & Hair Thickened Dry skin generally; hair- Scalp hair thinning (alopecia) and coarsened

Legs Non-pitting oedema

Neurological Slow/ delayed reflexes