The first feature of the examination of the thyroid is observance of the demeanour of the patient. Hypothyroid disease may cause apathy; thyrotoxicosis may result in a patient who seems quite hypomanic, although more rarely may cause apathy.
Shaking the patient's hand allows the examiner to gauge any temperature change, and a hand dripping with sweat (as opposed to the physiological diphoresis associated with a visit to the doctor) may be significant.
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