Thyroid

Question 1

1

Answer 1

Intro

“today ive been asked to examine your thyroid which is a gland in your neck… is this ok? this will involve me generally inspecting and then having a feel and closer look of the neck as well.”

seat patient comfortably in a chair that you can walk around on all sides

Question 2

2

Answer 2

Inspect general appearance

agitated/anxious/fidgety

Question 3

3

Answer 3

Hands

If you could just bring your hands up like this and spread your fingers

Place paper on it?

Turn hands over - inspect - for dry skin and palmar

inspect temp

Question 4

4

Answer 4

Feel hands for sweat

Question 5

5

Answer 5

Pulse

And inspect forearm for muscle wasting

Question 6

6

Answer 6

Inspect face - dry/sweaty

Question 7

7

Answer 7

Eyes

“I’m just going to inspect the eyes, if you could just look on a point on the wall behind me” - inspect straight on

“I’m now going to look from side”

And now from behind - “can you look up for me”

Question 8

8

There’s so much of eye test, just look from side, front, back. h test, fundoscope (if there) and get them to look up and down

Answer 8

H test

“gonna do some movements with my hand, if you could follow my finger, let me know if you have any pain or double vision.”

Also Inspect for lid lag by asking the patient to look up then down. Delayed
downward movement of the eyelids on downgaze indicates lid lag

if fundoscope there then this is where you use it

Question 9

9

Answer 9

Inspect neck - have a look (scars/goitre) and MASSES

“im going to more closely inspect the neck now, if you could just stay as you are”

FIRST BIT OF THYROID IS INSPECTING

Question 10

10

Answer 10

Water

if you could take a sip of this water and hold it in your mouth…….and swallow.

Question 11

11

Answer 11

Stick tongue out (observing neck).

inspect back of tongue for lingual thyroid

Question 12

12

Answer 12

Palpate

• trachea
• mass
• lymph nodes

Question 13

12

Answer 13

FROM BEHIND PALPATE THE ANTERIOR NECK. IF THERE IS A MASS…(determine size, nodular, feel above mass, surrounding tissues mobile..)

“I’m now going to feel your neck as well”

info on next card
assess for symmetry of the thyroid lobe elevation

Question 14

13

Answer 14

start feeling the thyroid cartilage (Adams apple), as you move downwards you’ll reach the superior edge of the cricoid cartilage. below this is the isthmus of thyroid. palpate the isthmus and then assess each thyroid lobe individually. hold it there and then ask the patient to stick their tongue out and take another sip of water

Question 15

14

Answer 15

Palpate the lymph nodes

Question 16

15

Answer 16

Percuss
retrosternal - just go three times quite high up on the restrosternum

“now going to tap on your chest”

INSPECT -> PALPATE -> PERCUSS -> AUSCULTATE

Question 17

16

Answer 17

“finally im going to listen. if you could take a deep breath and hold your breath there!!!(MS)….and breath normally”

Ask the patient to hold their breath. Auscultate with the bell of the stethoscope over
the lobes of the thyroid gland for bruits

Question 18

17

Answer 18

Special test

• reflex
• shins
• up from chair

HYPOREFLEXIA - ankle reflex (bicep if just sat on chair)

“id just like to finish with some special tests. were going to start with some reflexes in your leg, if you could just lie your hands flat like this, fully relaxed blah blah, hands facing up”

just the one on each arm

hyporeflexia - hypothyroidism

Question 19

18

Answer 19

Look at shins

“ask to roll trousers up and look at shins”

Question 20

19

Answer 20

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

Question 21

20

Answer 21

Summary

I performed a…
There was no peripheral stigmata of thyroid disease
No thyroid eye disease
There was no goitre

To complete:
TSH/T4 blood levels