• Easy irritability, nervousness, insomnia

• Fatigue

• Weight loss with increased appetite

• Frequent defaecation

• Oligomenorrhoea

• Dislike for hot weather, heat intolerance, excessive sweating

• Palpitations, dyspnoea

• Family history of thyroid disease

• Proximal muscle weakness, muscle atrophy, periodic paralysis (particularly in patients of Oriental extraction).

• While shaking hands with the patient note the warm sweaty palms.

• Look for tremor, thyroid acropachy (Fig. 136.1; a hypermetabolic state leading to axial bone destruction; do not confuse it with clubbing, which is usually painless), onycholysis (Plummer’s nails), vitiligo and palmar erythema.

• Check pulse for tachycardia or the irregularly irregular pulse of atrial fibrillation.

• Comment on proptosis (after looking at the eyes from behind and above)

• Check for lid lag

• Check for scars of previous tarsorraphy.

• Mention previous thyroidectomy scar if present

• Examine the neck for goitre and auscultate over the gland.

• Gynaecomastia can occur in men as a result of increased oestrogen production.

• Examine the cardiovascular system: sinus tachycardia, widened pulse pressure, loud first heart sound, third heart sound, systolic murmur, atrial fibrillation.

• Examine the shins for pretibial myxoedema (bilateral pinkish, brown dermal plaques; see Fig. 139.1).

• Test for proximal myopathy with hyper-reflexia.

• that you would like to check for thyroid-stimulating antibodies (TsAb): near 100% detection rate in patients with Graves’ disease.