Thyroid Exam

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Contents 1 The Thyroid Exam 1.1 Vital Signs 1.2 Inspection 1.3 Palpation 1.3.1 Anterior Approach 1.3.2 Posterior Approach 1.4 Auscultation 1.5 Special Tests 2 Videos of Proper Examination 3 Signs of Thyrotoxicosis 3.1 General 3.2 GI 3.3 Dermatological 3.4 Cardiovascular 3.5 Neurological 3.6 Musculoskeletal 3.7 Opthalmologic 3.7.1 Grave's Disease Opthalmopathy 4 More OSCE Modules

[edit] The Thyroid Exam

[edit] Vital Signs

• HR (brady/tachycardia)
• BP (wide pulse pressure)

[edit] Inspection

• medial and inferior, isthmus crosses trachea between 2nd and 4th tracheal ring
• each lobe should be no larger than the distal phalanges of the patient’s thumb
• obliteration of the medial borders of SCM muscles
  • have the patient slightly extend their neck and to swallow a sip of water
  • assess for a ≥ 2 mm increase in the horizon of the lateral view of the neck over the area of the thyroid isthmus, especially if it moves upwards during swallowing
• assess for asymmetry, masses, erythema, deviation of the trachea

[edit] Palpation

• cervical nodes, tracheal deviation
• CAROTID PULSE - absence indicates malignant thyromegaly (Berry’s Sign)
• Tenderness
• start from under the suprasternal notch, medial the SCM

[edit] Anterior Approach

• face the patient sitting, have pt turn head to relax a SCM; with your hand, displace the trachea to that side and palpate while she swallows

[edit] Posterior Approach

• index finger just below the cricoid
• displace trachea and palpate as the patient swallows

• DESCRIBE: size, symmetry, consistency

[edit] Auscultation

• over thyroid lobes for a BRUIT (thyrotoxicosis)

[edit] Special Tests

PEMBERTON’S TEST

• elevate, extend, rotate both arms for 3 min
• goiter → presyncope, SOB, cyanosis, plethora (compression of artery and veins)

[edit] Videos of Proper Examination

• Medical Examination of thyroid Gland
• Surgical Examination of a thyroid swelling
• Examination of clinical status of thyroid hormones

[edit] Signs of Thyrotoxicosis

[edit] General

• fatigue
• agitation, nervousness
• heat intolerance

[edit] GI

• ↓ weight

[edit] Dermatological

• warm and moist skin
• fine hair
• thyroid acropatchy (clubbing)
• onycholysis
• pretibial myxedema

[edit] Cardiovascular

• tachycardia
• ↑ pulse pressure, systolic outflow tract murmurs
• a fib

[edit] Neurological

• fine tremor - place piece of paper on patient's outstretched hand
• hyperreflexia

[edit] Musculoskeletal

• proximal muscle weakness

[edit] Opthalmologic

• lid lag
• stare with ↓ blink
• widened palpebral fissures

[edit] Grave's Disease Opthalmopathy

• proptosis/exopthalmos - bulging eye
• chemosis - eye irritation
• EOM dysfunction (up gaze)
• corneal ulcerations
• optic nerve entrapment

[edit] More OSCE Modules