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Endocrine 2 > Phys Di - Thyroid > Flashcards

Phys Di - Thyroid Flashcards

1
Q

What are the endocrine ROS?

A
  1. growth & development issues
  2. abnormal hair growth and/or patterns
  3. polyuria, polydipsia, polyphagia
  4. h/o diabetes, h/o thyroid issues
  5. galactorrhea
  6. diaphoresis
  7. temperature intolerance
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2
Q

What are the neck ROS?

A
  • Swelling
  • Lumps
  • Goiter
  • Pain
  • Limitation of Movement
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3
Q

What types of past medical history would you want to ask about?

A
  • h/o thyroid issues
  • menstruation
  • sleep disturbances
  • changes in appetite
  • weight loss/gain
  • depression
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4
Q

What types of surgical history would you want to ask about?

A
  • surgeries in the neck or chest

- past thyroid surgeries

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5
Q

What types of family history would you want to ask about?

A

Family h/o diabetes or thyroid disease

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6
Q

What types of social history would you want to ask about?

A
  • drugs
  • alcohol
  • ask the patient how you cope with stress/what is your stress level?
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7
Q

What do you inspect on the neck?

A
  • Thyroid for masses/size (have patient extend neck)
  • Tracheal deviation
  • Carotid pulsations
  • Jugular venous pulsations/distention
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8
Q

Explain how to palpate the thyroid

A

palpate both lobes from behind for masses/fullness; ask patient to swallow; have patient turn head to each side

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9
Q

State the lymph nodes on the physical exam

A
  1. Anterior Cervical – side of the neck
  2. Posterior Cervical – back of the neck
  3. Occipital – base of the skull
  4. Preauricular – in front of the ear
  5. Postauricular – behind the ear on the mastoid bone
  6. Tonsillar – at angle of the jaw
  7. Submandibular – under the jaw bone
  8. Submental – underneath the chin
  9. Supraclavicular – just above the clavicle
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10
Q

Give 3 facts about the thyroid gland

A
  • Largest endocrine gland
  • Located on each side of the trachea, joined by the isthmus
  • Produces thyroid hormone (T3, T4)
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11
Q

Outline the inspection of the thyroid

A
  • From anterior and from lateral, ask patient to extend neck
  • Visualize landmarks (thyroid cartilage, cricoid cartilage, trachea)
  • Symmetry: does the neck look equal on both sides and there is straight line down to sternal notch?
  • Masses
  • Fullness
  • Tracheal position/deviation: note that trachea is midline
  • Ask the patient to swallow as you inspect …
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12
Q

Why would the examiner inspect as the patient swallows?

A
  • helps examiner identify the thyroid tissue more accurately
  • thyroid and trachea move together
  • to evaluate a neck mass
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13
Q

How does normal swallowing affect the thyroid?

A

thyroid/trachea make an UPWARD movement of 2-3 cm, hesitates (< 1 sec), and then returns to original position

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14
Q

How can you tell if a mass is in the thyroid?

A

A mass is NOT in the thyroid if it doesn’t move during a swallow or it moves less than the thyroid cartilage.
e.g. a subcutaneous nodule or mass will NOT move with the swallow

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15
Q

What do you palpate for?

A

-Enlargement a.k.a. thyromegaly, goiter
-Tenderness (e.g. thyroiditis)
-Consistency (soft vs. firm)
“soft” = same consistency of the surrounding tissue = normal
-Firm in Hashimoto’s, malignancy
-Texture (smooth vs. nodular)

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16
Q

Outline the posterior approach technique

A
  • Be gentle! “Drift” over the gland
  • Use pads of 2-3 fingers (index, long, +/- ring)
  • Locate thyroid cartilage (Adam’s apple) first, then “map out” other anatomy
  • Ask patient to swallow with pads of fingers still on neck
  • Lateral lobes are lateral to trachea and will rise during swallow
  • Palpate both lateral lobes simultaneously
  • Have patient turn head away (R) to palpate left lobe and vice versa. Especially if you’re feeling something abnormal* questionable based on guest lecturer*
  • May need a second swallow (+/- water?)
17
Q

Palpation of thyroid

- what does normal feel like?

A
  • May be non-palpable
  • Lobes should be small
  • Texture should be smooth
  • Non-tender
  • Lobes should rise symmetrically with swallowing
  • Right lobe might be slightly larger than left
18
Q

Palpation of thyroid

- what is abnormal?

A
  • Enlarged/full = goiter
  • Coarse or gritty (inflammation)
  • Nodules (tiny masses)
  • Asymmetry of lobes
  • Tenderness (inflammation)
19
Q

Define goiter

A

an enlarged thyroid

*Note if unilateral, diffuse, nodular

20
Q

What is “rule of thumb” for the thyroid?

A

“Rule of thumb” : a lobe is enlarged if larger than the distal phalanx of the patient’s thumb

21
Q

When should you auscultate the thyroid?

-technique

A

**verbalize only for SPBL

  • Only helpful if goiter is present
  • Bell slightly better than diaphragm
  • If blood flow is increased (hyperthyroidism), a vascular bruit (soft, rushing sound) can be heard
22
Q

Characterize thyroid nodules

A
  • Occur in 5% of women and 1% of men
  • Most are NOT palpable
  • Mean diameter of a palpable nodule is 3 cm
  • If you palpate a nodule, note size and fixed vs. mobile
23
Q

What does it mean if a nodule moves with swallow?

A

If yes, it is attached to the thyroid

24
Q

What is the best diagnostic test to evaluate a thyroid nodule?

A

fine-needle aspiration (FNA)

25
Q

Hypothyroidism

-skin and soft tissue findings

A
  • NON-pitting edema a.k.a. myxedema
  • Periorbital edema
  • Coarse, thin hair and eyebrows
  • Yellow skin due to ↓ conversion of carotenoids to retinol
  • Cool skin due to ↓ dermal blood flow
  • Dry skin due to ↓ sebum production
26
Q

What is myxedema?

A

Dermal accumulation of mucopolysaccharides that freely bind water: “jelly-like swelling and overgrowth of mucus-yielding cement” which led Ord to coin the term myxedema in 1877

27
Q

Hypothyroidism

-neurological findings

A
  • Delayed reflexes
  • Hypothyroid Speech
  • -1/3 of hypothyroid patients
  • -Slow rate and rhythm
  • -Low-pitched, and hyponasal, sounds like they have a cold
28
Q

Is obesity more or less common in hypothyroidism?

A

Obesity is NO MORE COMMON in hypothyroid patients than in euthyroid patient!

29
Q

What is the MCC of hyperthyroidism?

A

Grave’s disease

30
Q

Physical findings in hyperthyroidism

  • general
  • eye
A
  • 70-93% have a goiter (diffuse and symmetrical)
  • thyroid bruit (up to 73%)

Eye findings:

  • -Lid lag: white sclera seen when looking down
  • -Lid retraction
  • -Bilateral Exophthalmos
31
Q

Physical findings in hyperthyroidism

-skin

A
  • -Warm, moist, and smooth due to ↑ sympathetic tone to sweat glands and ↑ dermal flow
  • -Pretibial myxedema –> bilateral, asymmetrical raised firm plaques/nodules, pink to purple-brown, over anterior shins
32
Q

Physical findings in hyperthyroidism

- neuromuscular

A
  • Weakness and diminished exercise tolerance
  • Fine hand tremor due increased sympathetic tone
  • Brisk reflexes
33
Q

Physical findings in hyperthyroidism

- cardiovascular

A
  • Tachycardia > 90 beats/min

- Symptom of palpitations

34
Q

Physical findings of Cushing’s syndrome (hypercortisolism)

A
  • Moon facies
  • Buffalo hump
  • Wide purple striae
  • Pendulous abdomen
  • Central fat distribution
  • Periorbital edema
  • Thin skin
  • Supraclavicular fat pads
  • Acne
35
Q

Physical findings of Addison’s Disease (1⁰ Adrenal Insufficiency)

A
  • Hyperpigmentation
  • Bronze skin
  • Vitiligo
  • Loss of body hair
  • Oral mucous membrane hyperpigmentation
36
Q

Physical findings of Hypoparathyroidism (↓ calcium, ↑ phosphate)

A
  • Tetany
  • Trousseau’s Sign: carpal spasm induced by inflation of BP cuff
  • Chvostek’s Sign: facial twitch caused by percussion of facial nerve
  • Hair Loss
  • Cataracts
  • Papilledema
37
Q

Other physical findings

A
  • Diabetic Cheiropathy (AKA Stiff Hand Syndrome)

- Acanthosis Nigricans (often seen in insulin resistance)

38
Q

Causes of gynecomastia

A
  • CKD
  • Cirrhosis
  • Drugs
  • Hyperthyroidism
  • Hypogonadism
  • Testicular tumors
  • Ectopic Production of hCG
  • Feminizing Adrenocortical Tumor

Endocrine 2 (15 decks)

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