Family histories are frequently positive for goiters, Graves' disease, or thyroiditis. The onset of the disease may be abrupt but is usually insidious. The average duration of symptoms prior to treatment is approximately 1 year. In retrospect, most families and teachers note that school performance decreased significantly several months before thyrotoxicosis became apparent. Typical complaints include nervousness, irritability, excessive sweating, emotional lability, increased appetite, insomnia, headache, and weight loss.
Patients often complain of being extraordinarily fatigued but unable to sleep.
School performance is typically affected by a shortened attention span, restlessness, and deterioration in penmanship. Physical examination usually reveals persistent tachycardia, systolic hypertension with a wide pulse pressure, eyelid retraction, tremulousness of outstretched hands, and smooth, moist, warm skin. Reflexes may be increased and there may be the presence of fine, straight hair. The thyroid gland is usually diffusely enlarged, however, the right lobe may be slightly larger than the left. Ophthalmopathy is a less serious problem for children.