USMLE Internal Medicine Review 11 09 Signs and Symptoms of Graves

USMLE Internal Medicine Review 11 09 Signs and Symptoms of Graves

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Let’s start our USMLE Review with Hypothyroidism and Hyperthyroidism from the Gold Standard USMLE Foundations of Medicine Audio Review program.

 

Play USMLE Audio MP3 11 09 Signs and Symptoms of Graves Below

 

Begin 11 09 Signs and Symptoms of Graves Transcription

Moving on to clinical signs and symptoms of Graves’ disease. Please pause the tape and list as many as you can think of for younger Graves’ disease patients.

  • In younger Graves’ disease patients manifestations include diarrhea, easy fatiguability, excessive sweating, hyperkinesia, and intolerance to heat with preference to cold, nervousness, and palpitations. There is often marked weight loss without loss of appetite. And thyroid enlargement and mild tachycardia may also be present.

Is a young Graves’ disease patient likely to suffer significant muscle weakness?

  • Yes, definitely muscle weakness and loss of muscle mass can be severe enough that the patient can’t get out of a chair without help.

And what is the likely growth pattern for children with Graves’ disease?

  • Children with Graves’ disease usually experience rapid growth with accelerated bone maturation.

Student doctor please pause the tape and repeat clinical signs and symptoms of Graves’ disease in younger patients.

  • Clinical signs and symptoms in younger Graves’ disease patients include diarrhea, easy fatiguability, excessive sweating, and hyperkinesia, intolerance to heat with preference for cold, nervousness, and palpitations. There is often marked weight loss without loss of appetite. And thyroid enlargement and mild tachycardia may also be present. There’s also severe muscle weakness. Children with Graves’ disease usually experience rapid growth with accelerated bone maturation.

Which two categories of signs and symptoms predominate in Graves’disease patients over 60?

  • Graves’ disease patients over 60 have mostly cardiovascular and myopathic complaints.

Please pause the tape and try to give the five most common presenting complaints with this Graves’ disease patient population.

  • Graves’ disease patients over 60 most often complain of dyspnea on exertion, nervousness, palpitation, tremor, and weight loss. Thickening of the skin, particularly over the lower tibia, is a rare symptom of Graves’ disease occurring in two to three percent of patients.

What’s the term for this symptom?

  • Thyroid dermopathy. Skin is so thickened it cannot be picked up between the fingers.

Thyroid dermopathy is due to what accumulation?

  • Due to accumulation of glycosaminoglycans.   If present bony involvement with subperiosteal bone formation and swelling with Graves’ disease is most evident in which bones? In the metacarpal bones.

And what is the term for a finding in Graves’ disease of separation of the fingernails from their beds?

  • Onycholysis.

Student doctor please pause the tape and summarize clinical signs and symptoms of Graves’ disease in patients over 60 years of age. Also mention dermopathy and bone and nail bed abnormalities.

  • Graves’ disease patients over 60 have mainly cardiovascular and myopathic symptomatology. Their chief presenting complaints include dyspnea on exertion, nervousness, palpitations, tremor, and weight loss. Thyroid dermopathy is a thickening of the skin over the lower tibia and sometimes extending over the entire lower leg and onto the feet. It is caused by accumulation of glycosaminoglycans and affects 2-3% of Graves’ disease patients. When present, bony involvement with subperiosteal bone formation and swelling is most evident in the metacarpal bones. Onycholysis, a separating of the fingernails from their beds, is also sometimes seen. This typically resolves as the patient’s condition improves.

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