The patient will appear nervous and anxious as a general rule and indeed may be thought to be suffering from anxiety only. Most patients will be losing weight, in spite of a good appetite, although occasionally they may be anorexic (without appetite).

They complain of frequent and loose bowel action. They tend to be breathless and though often hyperactive, tired at the same time.

There is a usual complaint of feeling hot much of the time, always turning down the heating and they become aware of palpitations, either because the heart beats too fast or the pulse has become irregular

List of symptoms the patient may experience

• Palpitations
• Heat intolerance
• Nervousness
• Insomnia
• Breathlessness
• Increased bowel movements
• Light or absent menstrual periods
• Fatigue
• Weakness
• Sleeping difficulty
• Itching overall
• Heartbeat sensations
• Diarrhoea

Signs

The doctor will look for the following. Weight loss may well be apparent in a number of patients but certainly not all. There may be staring eyes, the result of the fat behind the eyes swelling partly with fluid; this is called exophthalmos.

One classic sign is lid-lag, where the doctor asks the patients to look at his finger as he rapidly drops it in front of their vision. The upper lid lags behind the eye following the finger.

The pulse will be rapid, sometimes irregular and the hand will be unexpectedly warm to the touch; obvious too, will be the tremor of the hand.

The extra blood flow to the thyroid can sometimes be picked up by the doctor through his stethoscope; he can hear a rushing noise, which is called the thyroid bruit.

The blood pressure will be revealing too; the upper (systolic) value will be unusually widely separated from the lower (diastolic) value stop. Another typical finding is pre-tibial myxoedema, a puffiness apparent over the bone of the lower leg.

Armed with all this information, the diagnosis should be clear. Confirmatory blood tests will show abnormally high T4 and/or T3 levels and abnormally low TSH which, together with the presence of antibodies (TgAb) will suggest autoimmune thyroiditis.

Clearly, the diagnosis in general isnt difficult to make. The rub comes in the treatment.

List of signs

Signs are those things that a physician can objectively detect or measure.

• Fast heart rate
• Trembling hands
• Weight loss
• Muscle weakness
• Warm moist skin
• Hair loss
• Staring gaze
• Skin blushing/flushing
• Pulse bounding
• Nausea and vomiting
• Breast development in men
• Blood pressure high
• Protruding eyes (exophthalmos)
• Goitre