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CONDITION/DISORDER SYNONYM

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  • Diffuse thyrotoxic goiter

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ICD-9-CM CODES

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  • 242.0 Toxic diffuse goiter

  • PT diagnoses codes that may be secondary to thyroid disorders

    • 315.4 Developmental coordination disorder

    • 709.2 Scar conditions and fibrosis of the skin

    • 719.70 Difficulty in walking involving joint site unspecified

    • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified

    • 728.89 Other disorders of muscle, ligament, and fascia

    • 729.9 Other and unspecified disorders of soft tissue

    • 781.2 Abnormality of gait

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

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ICD-10-CM CODES

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  • E05 Thyrotoxicosis (hyperthyroidism)

  • E05.0 Thyrotoxicosis with diffuse goiter

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PREFERRED PRACTICE PATTERNS1

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  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning

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FIGURE 47-1

Graves disease. Note the proptosis of the eyes, thyroid acropachy, and the thyroid dermopathy on the pretibial region. (From Goldsmith LA, Katze S, Gilchrest B, Paller A, Leffel D, Wolff K. Fitzpatrick’s Dermatology in General Medicine, 8th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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PATIENT PRESENTATION

A 35-year-old female presents with complaints of a rapid heartbeat, excessive sweating, difficulty sleeping, irritability, and weight loss of 25 lb in the last 4 months despite having an increased appetite. Upon further questioning, she reports frequently feeling hot, having increased loose stools or diarrhea, and thinning of her hair. She has no other past medical history. Family history reveals a history of maternal “thyroid issues” and paternal hypertension. Past routine physical examinations document heart rates in the 70s and blood pressures around 110/70, but today her blood pressure is 135/90 and heart rate is 110 beats per minute. On examination, you note a fine tremor in her hands, bulging eyes, pretibial myxedema (PTM), and a diffusely enlarged thyroid.

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KEY FEATURES

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Description
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  • Graves disease is an autoimmune disorder

  • Overactivity of the thyroid gland (hyperthyroidism)

  • Produces excessive amount of thyroid hormone

  • Enlargement of the thyroid gland

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Essentials of Diagnosis
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  • Diagnosis is made by the symptoms

  • Thyroid hormone test

  • Onset of symptoms is often insidious

  • Symptoms build over a period of time, which can delay diagnosis

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General Considerations
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  • Diagnosis for more occult problems may take time and require intensive medical diagnostic testing

  • May cause pathology in multiple organ systems

    • GI: Liver

    • Cardiovascular: Heart, peripheral circulation, blood pressure

    • Integumentary

  • May result in secondary problems

    • Aerobic capacity and muscle endurance impairment

    • Sarcopenia

    • Weakness/impaired muscle performance

    • Musculoskeletal problems

    • Neuromuscular problems

    • Weight gain indicating the need for PT intervention, depending on severity

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