Thyroid Flashcards
End of bed
Hyper - thin, sweaty, tremor, flushed, fidgety, bulging / staring eyes
Hypo - obese, dry skin, inappropriately dressed, puffy eyes, thin hair
Hands and arms - Hyper
Acropachy (Graves' disease) Hot and sweaty Erythema Paper on hand to detect fine tremor Tachycardia AF
Hands and arms - Hypo
Cold and clammy
Bradycardia
Face and eyes - Hyper
Flushed
Proptosis (bulging of eyes anteriorly out of orbit)
Exophthalmos (sclera visible below iris)
Chemosis and periorbital oedema
Lid lag
Ophthalmoplegia - paralysis of one or more of extraocular muscles (upgaze usually effected)
Face and eyes - Hypo
Peaches & Cream tint
Puffy
Inspection of neck
Inspect from front and sides - obvious goitre just below thyroid cartilage
Swallowing - thyroid should move upward on swallowing
Stick out tongue - thyroglossal cyst will move upwards
Palpation
Stand behind patient
Tenderness - diffuse = viral thyroiditis, localised = bleeding into thyroid cyst
Use both hands to examine
Size, shape, symmetry - diffuse, nodular. smooth, multinodular
Consistency - soft (normal), firm (simple goitre), rubbery hard (Hashimotos’s), stoney (malignant, cystic calcification, fibrosis)
Mobility
Thrill
Lymph nodes of head and neck
Percussion
From xiphisternum to suptasternal notch - goitre extending retrosternally may produce a dull note
Auscultation
Bruit indicative of Graves’ (rule out aortic stenosis if bruit heard by auscultation of aortic area)
Special test - Pemberton’s
Very large goitre causing thoracic inlet obstruction
Ask pt to life arms above head
Look for plethora, cyanosis, dizziness and be ready to catch incase of syncope
Listen for stridor
Other
Reflexes - brisk in hyper, slow in hypo
Proximal myopathy - ask pt to stand from seating position with arms crossed
Oedema - pretibial myxoedema (Graves’ but rare), non-pitting peripheral oedema (hypo)
Relevant investigations
TFTs
Transillumination
USS
Fine needle aspiration
