Thyroid Examination

Thyroid Examination

Make the patient sitting, expose the head, neck and upper chest

1- look at the whole patient- sitting still or agitated, looking nervous or slow in his/her movement
- thin or fat
- wasting or fating
- generalized loss of weight or localized wasting to face, shoulder, hand
- is he/she sweaty or feel cold
- myxoedema face
- any hair loss (especially the outer tow thirds of the eyebrows)

2- look at the hand- feel the pulse : Tachycardia  thyrotoxcosis
Bradycardia  myxoedema
Collapsing pulse
- the palms moist, sweaty?
- palmar erythema
- peripheral cyanosis
- pallor
- test for fine tremor (patient hold his/her arms out in front of them, elbow and wrist straight , fingers straight and separated)

3- look at the eye
- lid retraction (upper eyelid is higher than the normal)
- lid lag
- exophthalmos (eyeball is pushed forwards)
- ophthalmoplegia (patient can not look upwards or outwards)
- chemosis (edema of conjunctiva)

4- inspect the neck from the front and either side- surface,
- site,
- Shape (diffuse, nodular. Symmetrical, asymmetrical)
- size,
- color (redness)
- there is any scar for a previous surgery?
- any other swellings
- is there any distended veins?
- look for the position of thyroid cartilage, at center or deviated?
- It moves with the swallowing or not??
- It moves with the protrusion of the tongue or not?
- pemberton's sign

5- palpate the neck from the front
- tenderness,
- temperature
- measure the circumference
- mobility ( relation to surrounding tissues : -muscles
- Skin --tethering
-- fixation
- trachea (at center or deviated)
- carotid artery pulse (is it displaced?)

6- palpate the neck from behind
- ask the patient to swallow while you are palpating
- tenderness, shape, surface, size, consistency, thrill, Pulsatility, borders, mobility, temperature
- determine the lower border of the gland
- Palpate the cervical lymph nodes

7- percussion
To define the lower extent of a swelling that extends below the suprasternal notch

8- auscultation:
For a systolic bruit

-Look for any proximal myopathy
-Check the reflexes

(Note: if you suspect cervical lymphadenopathy, or enlargement of a salivary glands there is another examination for them)

Here is Video

around 20 MB

http://www.etu.sgul.ac.uk/cso/skills...id/thyroid.wmv