Examination Of The Thyroid Gland

Question 1

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Answer 1

Equipment needed: glass of water, tendon hammer, stethoscope, sheet of paper

Seat them in a chair that you can walk around on all sides

Intro

Listen to their voice (low pitch/ hoarse may indicate hypothyroidism)

Question 2

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Answer 2

Inspect the general appearance of the patient (build, inappropriate clothing, restlessness, confusion, quality of skin and hair)

Question 3

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Answer 3

Inspect the hands for thyroid signs:
-Temp!!!
-Sweating
-palmar erythema
-clubbing
-brittle nails
-onycholysis (nail coming off the nail bed)

Question 4

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Answer 4

Check for a tremor by asking the patient to hold their hands outstretched and pronated (palms downwards).

Question 5

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Answer 5

Check the patients pulse (note tachycardia, bradycardia or atrial fibrillation)

Question 6

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Answer 6

Inspect the forearm for muscle wasting

Question 7

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Answer 7

Inspect the eyes for thyroid signs
(Look at notes for specific signs)

Question 8

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Answer 8

Inspect the neck for masses

Question 9

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Answer 9

Ask the patient to take some water in their mouth then observe the neck while they swallow it. Does the mass move? If so, this indicates a thyroid mass.

Question 10

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Answer 10

Ask the patient to protrude their tongue (“Stick your tongue out”). Observe the neck. If the mass moves upwards on tongue protrusion this indicates a thyroglossal cyst.

Question 11

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Answer 11

Inspect the back of the tongue for a lingual thyroid.

Question 12

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Answer 12

Palpate the trachea. Is it central?

Question 13

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Answer 13

From behind, palpate the anterior neck. (Check notes for if there is a mass)

Question 14

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Answer 14

Palpate the cervical lymph nodes for metastatic spread.

Question 15

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Answer 15

Percuss the upper sternum for retrosternal extension of the goitre. (Not obligatory as not useful clinically)

Question 16

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Answer 16

Auscultation
- Ask the patient to hold their breath. Auscultate with the bell of the stethoscope over the lobes of the thyroid gland for bruits (due to increased blood flow)

Question 17

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Answer 17

Check for proximal muscle weakness. Ask patient to rise from sitting on a chair whilst folding arms on chest.

Question 18

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Answer 18

Check the ankle reflexes. There may be normally brisk ankle reflexes which are slow to return to the resting state (delayed relaxation) in hypothyroidism.

Question 19

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Answer 19

Inspect for pretibial myxoedema.

Question 20

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Answer 20

Thank the patient