Endocrine History & Examination

Question 1

What are the typical symptoms of hyperthyroidism?

Answer 1

1. Heat intolerance
2. Weight loss
3. Hair loss
4. Anxiety/irratibility
5. Tremor
6. Menstrual irregularity
7. Frenetic activity

Question 2

What are the signs and symptoms of hypothyroidism?

Answer 2

1. Cold intolerance
2. Weight gain
3. Hair loss
4. Low mood
5. Hoarse voice
6. Menorrhagia
7. Lethargy

Question 3

What are the 2 stages involved in testing for hyper/hypothyroidism?

Answer 3

1. Examine the gland
2. Measure the activity of the gland through TSH and fT4

Question 4

What are the normal ranges for TSH and fT4?

Answer 4

TSH - 0.4 - 4.0 mU/L

fT4 - 9 - 25 pmol/L

Question 5

What should you look for when inspecting the neck?

Answer 5

Is there an obvious thyroid swelling?

Is it unilateral or bilateral?

Is it smooth or nodular?

Question 6

What should you do if you suspect a visible thyroid swelling?

Answer 6

Ask the patient to swallow

The thyroid muscles should move upwards as the pharyngeal muscles contract

Question 7

How do you distinguish between a thyroid swelling and a thyroglossal cyst?

Answer 7

Ask the patient to stick out their tongue

a thyroglossal cyst will move with protrusion of the tongue

Question 8

What is the first stage in palpation of the neck?

Answer 8

Examine for lymphadenopathy

beneath the mandible, in the anterior and posterior triangles of the neck and the supraclavicular fossae

Question 9

What is the second stage in palpation of the neck?

Answer 9

Palpate for any anterior neck swelling

if swelling is present, ask the patient to swallow

if you are palpating the thyroid gland, this should elevate when the patient swallows

Question 10

Complete the table for changes in hyperthyroidism and hypothyroidism

Answer 10

Question 11

What eye signs should be looked for?

Answer 11

Thyroid eye disease signs

e.g. Exophthalmos

Question 12

How should you ask the patient to be sat for palpation of the neck?

Answer 12

Ask the patient to sit upright, and examine the neck from behind

Question 13

What should you do if you suspect a thyroid swelling upon neck palpation?

Answer 13

Try to ascertain whether the swelling is soft or firm

and

whether there are any palpable nodules, either single or multiple

Question 14

What should be auscultated for during the neck examination?

Answer 14

bruits

this can be present in Grave’s disease

Question 15

Why are the legs inspected as part of a thyroid examination?

Answer 15

Pretibial myxoedema or generalised oedema may be present in hypothyroidism

reflexes will be brisk in hyperthyroidism and delayed in hypothyroidism

Question 16

How should the thyroid examination be concluded?

Answer 16

Thank the patient and explain the examination findings to the patient