Clinical features
Euthyroid means "normal thyroid function" and as such the main effects of this type of goitre are local and usually restricted to the adverse cosmetic effects of the enlarged gland. In very large goitres and in those, which enlarge below and behind the sternum (breastbone), the swelling can cause pressure on adjacent structures. Pressure on the trachea (windpipe) or the oesophagus (gullet) can cause breathing difficulties or problems with swallowing (dysphagia) respectively. These are serious complications that merit urgent treatment.
Hypothyroidism causes wide-ranging symptoms relating to reduction of the rate of metabolism. These can be tiredness, weakness, dry skin, feeling of cold, poor memory, low motivation, poor appetite but with weight gain, hoarse voice, coarse features and swelling of the legs.
Physical signs are slow pulse rate, cold extremities, puffiness of the face and extremities, hair loss and hair condition poor, and breathlessness.
The symptoms of hyperthyroidism reflect the wide-ranging effect of increase in metabolic activity. These include hyperactivity, irritability, altered mood, heat intolerance, sweating, palpitations, fatigue and weakness, weight loss with increased appetite, diarrhoea, increased urine output, altered menstruation and loss of libido. Physical signs found in this condition are rapid heart beat, sometimes irregular heartbeat (atrial fibrillation), fine tremor of the hands, warm, moist skin, goitre, palmar erythema (reddening of the palms), cracking of the nails, itching, skin rashes and diffuse skin pigmentation. Muscle wasting and weakness can occur with diffuse hair loss.
Particularly in Graves' disease the patient can develop typical changes to the appearance of the eyes, which become prominent and staring with retraction of the lids (proptosis and ophthalmoplegia). In rare circumstances where the disease develops rapidly or where the condition has been ignored or neglected it may present with signs of paralysis, psychotic illness and unconsciousness. Also in uncontrolled cases cardiac failure can develop.
