title: Hyperthyroidism and Graves' disease: Is an ultrasound examination needed?
abstract: OBJECTIVE
  The aim of our study was to assess the limitation of clinical examination in determining the morphology of thyroid gland in patients with hyperthyroidism and its implications.
  
  
  METHODS
  A retrospective analysis of consecutive patients with hyperthyroidism seen in a tertiary endocrine clinic were analyzed. Sub-analysis was performed on patients with proven Graves' disease.
  
  
  RESULTS
  Of the 133 patients included in this study with hyperthyroidism, 60 (45%) patients had significant nodularity on ultrasound (US). However, only 67% of these were identified on clinical examination. In patients with confirmed Graves' disease (n= 73), the discordance between US and clinical examination was very similar (18 of 30 patients, 60%).
  
  
  CONCLUSIONS
  US should form an essential part of the evaluation of hyperthyroidism as the morphology of thyroid gland could be variable and nodules in these glands would also need to be appropriately investigated. This would also significantly influence decision-making and appropriate immediate and follow-up management plan.
authors.affiliation: Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
authors.forename: Lakshminarayanan
authors.initials: L
authors.lastname: Varadhan
authors.affiliation: Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
authors.forename: George Iype
authors.initials: GI
authors.lastname: Varughese
authors.affiliation: Department of Diabetes and Endocrinology, WISDEM Centre, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: Sailesh
authors.initials: S
authors.lastname: Sankaranarayanan
keywords: Graves’ disease; hyperthyroidism; thyroid examination; thyroid nodules