Thyroid Exam

The Thyroid Exam

Vital Signs

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

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

Palpation

• 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

• 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

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

• DESCRIBE: size, symmetry, consistency

Auscultation

• over thyroid lobes for a BRUIT (thyrotoxicosis)

Special Tests

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

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

Signs and Symptoms of Thyrotoxicosis

General

• fatigue
• agitation, nervousness
• heat intolerance

GI

• ↓ weight
• diarrhoea

Dermatological

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

Cardiovascular

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

Neurological

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

Insomnia, restlessness, irritability

Musculoskeletal

• proximal muscle weakness

Opthalmologic

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

Grave's Disease Opthalmopathy

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

rosenbach;s sign fine tremoreson closure eye lid