Thyroid Flashcards
How is hyperthyroidism and hypothyroidism distinguished on a blood test?
Hyperthyroidism= TSH is low and T3 and T4 are raised
Hypothyroidism= TSH is high and T3 and T4 are low
what medication should go give someone with hyperthyroidism?
Carbimazole= antithyroid agent
+ propanolol to control heart rate
What medication should you give someone with hypothyroidism?
Levothyroxine
What should be looked for on general inspection of a patient?
anxiety, sweating and tremor= hyper,
dry skin, obese, periorbital oedema= hypo
What should be looked for on the hands?
temperature, sweating, palmar erythema, Clubbing, Brittle nails, Onycholysis, thyroid acropachy occurs in graves
Check for tremor
What should be checked on arms?
Radial pulse
Check forearm for muscle wasting
What should be looked for in the eyes
Look from the front: Inspect for lid retraction (sclera can be seen above cornea), chemosis (conjunctival oedema), conjunctival infection (blood shot eyes) and lid oedema,
Look from the side: proptosis/ exopthalmus (anterior movement of eyes from orbit)
Slow finger drop: Inspect for lid lag, delayed downward movement of eyelids on downgaze indicates lid lag
H test: look for diplopia and restricted eye movements
Test visual acuity and perform fundoscopy
What should be looked for the face and mouth
hypothyroidism= loss of outer eyebrow and dry skin
Inspect back of the tongue for lingual thyroid
What should be looked at in the neck (and mouth)
Visible masses?
Ask patient to swallow water and see if the mass moves, thyroid masses will move
Ask patient to protrude the tongue. Observe the neck, if mass moves up on tongue protrusion then it is a thyroglossal cyst
What should be palpated in neck?
Trachea,
Cervical lymph nodes,
Thyroid gland, feel with swallow and tongue protrusion
What should be percussed?
Upper sternum for retrosternal goitre
What should be auscultated
Listen with bell over lobes of thyroid for bruits
What else should you do?
Check ankle reflexes,
Inspect for pre tibial myxoedema
