Thyroid Exam
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