Thyroid Flashcards
Goitre/neck lump exam: inspection
Look from front and sides
Position - midline, ant/post triangle
Swallow water
Stick out tongue
Goitre/neck lump exam: palpation
Feel from centre. Comment on: Consistency Texture Size Symmetry Nodules Edge Size Fluctuant: lipoma Pulsation: carotid body tumour Can you get below it
Swallow water
Stick out tongue
Lymph nodes
Transilluminate
Goitre/neck lump exam: overview
Inspection
Palpation
Percussion - xipisternum to sternal angle
Ausc - both sides
Pemberton’s test - raise arms and look for facial swelling (SVCO)
Thyroid status exam: general inspection
Hyper:
Agitated, sweaty
Hypo:
Dressed warmly
Pale
Thyroid status exam: hands
Clubbing 4Ps - palms - hot, cold, dry, moist - pulse - af/tachy/brady - palmar erythema - paper test - tremor
Thyroid status exam: face
Eyebrows, hair loss Flushing/pallor Exopthalasmus Lid retraction H-test - upwards diplopia Lid lag - up and quickly down, from side
Thyroid status exam: limbs
Proximal myopathy - U + L - hyper Biceps and knee reflexes Temperature CTS - hypo Oedema
Concluding a thyroid exam
Assess thyroid function if not already done so
TFTs USS FNA Proximal myopathy: U&E, IGF-1, ACTH Refer to endocrine if necessary
DDx neck lump
Midline:
Goitre
Thyroglossal cyst
Ant triangle:
Bronchial cyst
Carotid body tumour
LN
Post triangle:
Cystic hygroma (above clavicle)
LN
Anywhere:
Lipoma
Sebaceous cyst
DDx for goitre
Multinodular Graves Adenoma/carcinoma Hashimotos Subacute thyroiditis
DDx for hyperthyroidism
Graves
Toxic multinodular goitre
Toxic adenoma
Initial phase of thyroiditis - subacute, post partum, hashimotos
DDx for hypothyroidism
Autoimmune
- hashimotos
- atrophy
Acquired:
- iodine deficiency
- iatrogenic (surgery, radioiodine, amiodarone, carbimazole, lithium)
- subacute thyroiditis
Management of hyperthyroid
Symptom control - bblockers
Reduce thyroxine - carbimazole
Radioactive iodine
Surgery
Graves specific symptoms
Exophthalmos
Opthalmoplegia - upwards gaze
Pretibial oedema
Clubbing
Note: lid lag and retraction can be caused by any cause of hyperthyroidism, not graves specific
Graves vs toxic multinodular goitre
Graves:
Smooth
TSH-r Ab +
Graves specific signs
Toxic MNG:
Nodular
None of the above
