Goitre Flashcards
Causes of Goitre
A) Euthyroid
- Physiological goitre at puberty
- Compensated hypothyroid - Endemic- iodine deficiency goitre; Dyshormonogenesis
- Hashimoto’s thyroiditis
B) Thyrotoxicosis
- Grave’s disease
- Hashimoto’s thyroiditis
C) Hypothyroid
- Endemic goitre
- Goitrogens in food or drugs
- Dyshormonogenesis
- Hashimoto’s thyroiditis
Steps in physical examination of Goitre
A. Local examination of neck swelling -
- Demonstrate it is a Goitre: moves with swallowing, not move with tongue protrusion
- Note if the goitre causes pressure effect: Stridor, dysphagia, tracheal deviation
- Palpate for size, shape, consistency, tenderness, thrill, retrosternal extension, carotid pulse and cervical lymph nodes
- Listen for bruits (sign of toxic goitre)
B. Look for sign suggesting hyper/ Hypothyroidism
(Mentality> face > hand & skin > CNS)
1. Talk to child to assess his mentality/ hearing
2. Note child’s facial appearance ? coarse
3. Note one’s height and measure body proportions
4. Skin and hair texture and temperature
5. Eye examination
6. Hand examination (temp, pulse, sweating, clubbing, tremor and pulse rate)
7. LL examination for jerk and pretibial oedema
8. Abdomen for umbilical hernia
9. Look for cerebellar sign if indicated
(Acropachy due to soft tissue swelling and subperiosteal reaction)
Thyrotoxicosis
Tall
Normal mentality, Anxious
Eye- Exophthalmos, lid retraction/ lag, ophthalmoplegia
Skin- warm and sweaty
Hands- Tremor, Tachycardia, bounding pulse
Hypothyroidism
Short, infantile proportion Mentally slow Body weight > expected Skin - dry, coarse, cold Hair - dry, sparse and coarse Bradycardia Umbilical hernia Slow relaxation of Jerks Ataxia Speech and hearing loss in Pendred syndrome