Thyroid Exam

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The Thyroid Exam[edit]

Vital Signs[edit]

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

Inspection[edit]

  • 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

Palpation[edit]

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

Anterior Approach[edit]

  • 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

Posterior Approach[edit]

  • index finger just below the cricoid
  • displace trachea and palpate as the patient swallows
  • DESCRIBE: size, symmetry, consistency

Auscultation[edit]

  • over thyroid lobes for a BRUIT (thyrotoxicosis)

Special Tests[edit]

PEMBERTON’S TEST

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

Videos of Proper Examination[edit]

Signs and Symptoms of Thyrotoxicosis[edit]

General[edit]

  • fatigue
  • agitation, nervousness
  • heat intolerance

GI[edit]

  • ↓ weight
  • diarrhoea

Dermatological[edit]

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

Cardiovascular[edit]

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

Neurological[edit]

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

Insomnia, restlessness, irritability

Musculoskeletal[edit]

  • proximal muscle weakness

Opthalmologic[edit]

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

Grave's Disease Opthalmopathy[edit]

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

rosenbach;s sign fine tremoreson closure eye lid

More OSCE Modules[edit]