Typical Exam Findings in Hashimoto's Thyroiditis
The most common physical exam finding in Hashimoto's thyroiditis is a diffuse, firm, non-tender goiter, though many patients may have no obvious thyroid enlargement. 1, 2
Key Physical Examination Findings
Thyroid Examination
- Goiter characteristics:
- Diffuse enlargement (present in approximately 79% of patients) 3
- Firm to rubbery consistency
- Non-tender on palpation
- Symmetrical enlargement
- Surface may feel irregular or "pebbly"
Signs of Thyroid Dysfunction
Depending on the current phase of thyroid function, patients may present with:
Hypothyroid Signs (most common in Hashimoto's):
- Dry, cool skin
- Facial edema, particularly periorbital
- Bradycardia
- Delayed relaxation phase of deep tendon reflexes
- Coarse, brittle hair
- Pallor
- Weight gain despite no change in diet
- Cold intolerance
Hyperthyroid Signs (less common, during "hashitoxicosis" phase):
- Tachycardia
- Tremor
- Warm, moist skin
- Hyperactive reflexes
- Weight loss
- Heat intolerance
Associated Exam Findings
Dermatologic
- Vitiligo
- Alopecia areata
- Myxedema (in advanced hypothyroidism)
- Carotenemia (yellowish skin discoloration)
Cardiovascular
- Bradycardia (in hypothyroid state)
- Diastolic hypertension
- Pericardial effusion (in severe cases) 1
Neurological
- Delayed relaxation of deep tendon reflexes
- Carpal tunnel syndrome
- Peripheral neuropathy
Musculoskeletal
- Proximal muscle weakness
- Joint stiffness
- Arthralgias
Associated Conditions to Examine For
Hashimoto's thyroiditis is frequently associated with other autoimmune conditions that may have their own physical findings 4, 1:
- Autoimmune thyroid disease (most common concurrent autoimmune condition - 10-23% of Hashimoto's patients) 4
- Systemic lupus erythematosus (2.8-3% of Hashimoto's patients) 4
- Sjögren's syndrome (2.8-7% of Hashimoto's patients) - look for dry eyes, dry mouth 4
- Rheumatoid arthritis (2-4% of Hashimoto's patients) - examine for joint deformities 4
- Type 1 diabetes - check for signs of poor glycemic control
- Celiac disease - assess for malnutrition signs
- Addison's disease - look for hyperpigmentation, orthostatic hypotension
Laboratory Findings
While not physical exam findings, important diagnostic markers include:
- Elevated thyroid peroxidase antibodies (TPO-Ab) and/or thyroglobulin antibodies (TG-Ab) 5
- TSH levels may be elevated (most common), normal, or decreased
- Free T4 levels may be low or normal
- Ultrasound typically shows abnormal thyroid appearance (98.6% of patients) 3
Clinical Pearls
- The absence of goiter does not rule out Hashimoto's thyroiditis.
- Patients may have normal thyroid function tests despite having Hashimoto's thyroiditis.
- The presence of other autoimmune conditions should raise suspicion for Hashimoto's thyroiditis.
- Thyroid ultrasound is rarely normal in patients with Hashimoto's thyroiditis 3.
- Patients may report multiple extrathyroidal symptoms despite being biochemically euthyroid 5.
Remember that Hashimoto's thyroiditis can present with varying degrees of thyroid dysfunction, and physical exam findings will reflect the current thyroid hormone status of the patient.