Thyroid Flashcards
How do you begin the examination?
Wash hands
Introduction
Identification
Consent
How should you position the patient?
Seated on a chair you can get around
What should you look for on general inspection?
Voice (low pitched - hypo) Build Clothing (warm/cold?) Restlessness Confusion Skin and hair quality
What thyroid signs do you look for in the hands?
Temperature Sweating Palmar erythema Clubbing Brittle nails Onycholosis
What do you palpate and look for in the hands?
Tremor (with paper)
Pulse
What do you look for in the forearms?
Muscle wasting
What signs do you look for in the eyes specific to graves?
Exopthalmos (bulging, inspect from above)
Chemosis (conjunctival oedema)
Bloodshot eyes
Eye movements in all directions (extraocular muscle myopathy)
Visual acuity
What eye signs are present for all types of hyperthyroidism?
Lid retraction
Lid lag
How do you test for lid lag?
Look up then down
Delayed downward movement of the upper eyelid
What do you inspect the neck for?
Masses
How do you assess if the mass is a thyroid mass?
Ask patient to swallow water
If the mass moves it is a thyroid mass
How do you assess if the mass is a thyroglossal cyst?
Ask patient to stick tongue out
If the mass moves upwards test is +ve
What do you inspect the back of the tongue for?
A lingual thyroid
What do you palpate from the front?
Trachea
What do you palpate for from behind?
A mass
What do you do determine if you find a mass?
Size and site Diffusely enlarged Hard or soft Smooth or nodular Fixed to surrounding tissues Can you feel above and below it? Does it move on swallowing Does it move when sticking tongue out?
What else do you palpate in the neck?
Cervical lymph nodes
What do you auscultate?
Over thyroid gland (breath held) for bruit
What finishing pieces are there?
Proximal muscle weakness (stand from chair arms folded)
Ankle reflexes
Pretibial myxoedema
What finding may you get when checking ankle reflexes?
Brisk slow relaxing in hypo
How do you finish the exam?
Thank patient
Wash hands
Present
