Thyroid Exam
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The Thyroid Exam[edit | edit source]
Vital Signs[edit | edit source]
- HR (brady/tachycardia)
- BP (wide pulse pressure)
Inspection[edit | edit source]
- 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 | edit source]
- 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 | edit source]
- 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 | edit source]
- index finger just below the cricoid
- displace trachea and palpate as the patient swallows
- DESCRIBE: size, symmetry, consistency
Auscultation[edit | edit source]
- over thyroid lobes for a BRUIT (thyrotoxicosis)
Special Tests[edit | edit source]
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 | edit source]
- Medical Examination of thyroid Gland
- Surgical Examination of a thyroid swelling
- Examination of clinical status of thyroid hormones
Signs and Symptoms of Thyrotoxicosis[edit | edit source]
General[edit | edit source]
- fatigue
- agitation, nervousness
- heat intolerance
GI[edit | edit source]
- ↓ weight
- diarrhoea
Dermatological[edit | edit source]
- warm and moist skin
- fine hair
- thyroid acropatchy (clubbing)
- onycholysis
- pretibial myxedema
Cardiovascular[edit | edit source]
- tachycardia
- ↑ pulse pressure, systolic outflow tract murmurs
- a fib
Neurological[edit | edit source]
- fine tremor - place piece of paper on patient's outstretched hand
- hyperreflexia
Insomnia, restlessness, irritability
Musculoskeletal[edit | edit source]
- proximal muscle weakness
Opthalmologic[edit | edit source]
- lid lag
- stare with ↓ blink
- widened palpebral fissures
Grave's Disease Opthalmopathy[edit | edit source]
- proptosis/exopthalmos - bulging eye
- chemosis - eye irritation
- EOM dysfunction (up gaze)
- corneal ulcerations
- optic nerve entrapment
rosenbach;s sign fine tremoreson closure eye lid