Thyroid

Question 1

What general things do you look for on inspection in a thyroid examination?

Answer 1

General appearance - build, inappropriate clothing, restlessness, confusion, quality of skin/hair, wasting ie of muscles of forearm

Question 2

What things do you look for on inspection of the hands in a thyroid examination?

Answer 2

Test with the backs of the fingers - temperature, sweating 
Brittle nails 
Palmar erythema
Onycholysis 
Clubbing - look from side on

Question 3

How do you examine for a fine tremor?

Answer 3

Ask patient to hold hands outstretched and pronated
Balance a piece of paper on the back of the hands
This will amplify any tremor

Question 4

Why do you take a pulse in a thyroid exam?

Answer 4

Look for tachyc./bradyc. or AF etc

Question 5

What things do you look for on inspection of the eyes in a thyroid examination?

Answer 5

Proptosis/exophthalmos - forward displacement of the eye (hyperthyroidism)
Chemosis (conjunctival oedema), conjunctival injection (bloodshot eyes), periorbital/lid oedema
Lid retraction - sclera seen above the cornea
Lid lag - get patient to follow finger up and down, delayed downward movement of eyelids = lid lag
H-test to check for any eye restriction?
Visual acuity and fundoscopy as proptosis can stretch the optic nerve

Question 6

What things do you look for on inspection of the neck in a thyroid examination?

Answer 6

Simply look to start with
Ask patient to take some water into their mouth then swallow on command - if the mass moves, indicates a goitre (though carcinomas can fix themselves to adjacent structures and not move)
Ask patient to stick out their tongue - if mass moves upwards, indicates a thyroglossal cyst
Inspect the of the tongue for a lingual thyroid

Question 7

What things do you look for on palpation in a thyroid examination?

Answer 7

Palpate trachea - central?Palpate anterior neck from behind - inferior to thyroid cartilage on superior portion of trachea
Palpate cervical and supraclavicular lymph nodes to check for metastatic spread

Question 8

What should be determined if a mass is found?

Answer 8

Size and site
Diffusely enlarged? Smooth or nodular? One or many?
Hard or soft?
Fixed to surrounding tissues or mobile?
Can you feel above the mass? And below in the suprasternal notch? (if not, retrosternal goitre?)

Question 9

What things do you look for on percussion in a thyroid examination?

Answer 9

Percuss the upper sternum

Listen for dullness - retrosternal extension of the goitre

Question 10

What things do you look for on auscultation in a thyroid examination?

Answer 10

Ask patient to hold their breath
Auscultate with the bell of the stethoscope over each lobe of the thyroid gland sequentially, listen to bruits (wooshing turbulence due to increased blood flow)

Question 11

What other things should be checked in a thyroid examination?

Answer 11

Check ankle reflexes (brisk which are slow to return to the resting state - hypothyroidism)
Inspect for pretibial myxoedema on shins