Disability Examination Worksheets
Thyroid and Parathyroid Diseases
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A. Review of Medical Records:
B.
Medical History (Subjective Complaints):
Comment on:
- Date diagnosis established.
- Fatigability.
- Mental assessment.
- Neurologic, cardiovascular, or gastrointestinal symptoms.
- Treatments (surgery, medications, hormones), including dose,
frequency, response, side effects. For C-cell hyperplasia, provide date of
completion of any treatment for malignancy.
- Symptoms due to pressure (on larynx, esophagus, etc.).
- Cold or heat intolerance.
- Constipation.
- Weight gain or loss.
C. Physical Examination (Objective Findings):
Address each of the following and fully describe current
findings:
- Thyroid size.
- Pulse and blood pressure.
- Eye and vision abnormalities.
- Muscle strength.
- Tremor.
- Myxedema.
- All other residuals of thyroid disease or its treatment.
D. Diagnostic and Clinical Tests:
Provide:
- T4, T3, TSH, and/or other thyroid function tests, if needed.
- If thyroidectomy scar is disfiguring, order color
photograph.
- Thyroid scan, if indicated.
- Include results of all diagnostic and clinical tests conducted
in the examination report.
E. Diagnosis:
Comment on:
1. Is the disease active or in remission?
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Reviewed/Updated Date: December 15, 2008 |
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