Clinical manifestations of hyperthyroidism reflect increased catabolism and excessive sympathetic activity caused by excess circulating thyroid hormones. Symptomatic manifestations of hyperthyroidism include weight loss despite normal or increased appetite, heat intolerance, anxiety, irritability, fatigue, muscle weakness, palpitations, and oligomenorrhea. Signs of hyperthyroidism include goiter, tremor, hyperreflexia, fine or thinning hair, thyroid bruit, muscle wasting, and cardiac arrhythmias such as sinus tachycardia or atrial fibrillation. The presentation of hyperthyroidism varies with age. Young patients typically present with hypermetabolism, while older patients may present primarily with tachyarrhythmias or cardiac failure. Rarely, elderly patients experience only muscle wasting, apathy, confusion, or a state of depression known as apathetic hyperthyroidism. Clinical features of hypothyroidism include cold intolerance; weight gain; constipation; edema of the hands, feet, and eyelids, dry skin; weakness; somnolence; and menorrhagia.
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