Disorders of the thyroid gland present in different ways.
Symptoms of thyrotoxicosis. The features include weight loss with increased appetite, heal intolerance, pruritus, emotional lability, excessive sweating and palpitations. There may he a change in the menstrua] cycle, either oligomenorrhoea or amenorrhoea, and in bowel habit as a consequence of intestinal hurry. In elderly patients many of these features may be missing and the presenting features may relate to the development of atrial fibrillation (see p. 85).
Symptoms of hypothyroidism. These include weight gain and constipation, apathy and forgetfulness, gruffness of voice and cold intolerance. In the elderly, symptoms tend to develop insidiously and may be unrecognised or wrongly attributed to the ageing process.
Goitre. Significant enlargement of the thyroid gland (goitre) is common. By definition, the lateral lobes of the thyroid have a volume in excess of the terminal phalanges of the thumbs of the subject. Goitre may be noted by the patient or by relatives and friends, but many subjects are unaware of its presence. The vast majority are asymptomatic. Tenderness may be associated with various forms of thyroiditis and acute pain may occur following bleeding into a thyroid cyst. Dysphagia is rare cxccpt when there is marked swelling of the gland. Its presence suggests a malignant process.
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