Thyroid

Question 1

What do you look for on general inspection?

Answer 1

If patient is agitated, fidgety, anxious (hyperthyroidism)

Question 2

What do you look for on inspection of the hands?

Answer 2

Thyroid acropachy (Graves')
Peripheral tremor (hyperthyroidism)
Palmar erythema (hyper)
Sweat (hyper)
Dry skin (hypo)

Question 3

What do you feel on palpation of the hands?

Answer 3

Pulse rate (fast in hyper, slow in hypo)
Pulse rhythm (AF in hyper)

Question 4

What do you look for on inspection of the face?

Answer 4

Sweating (hyper)
Dry skin, loss of outer third of eyebrow (hypo)
Exophthalmos (hyper)
H test for eye movements (restricted in exophthalmos)
Assess for lid lag

Question 5

What do you look for on close inspection of the neck?

Answer 5

Erythema
Thyroidectomy
Masses (goitre / lymph nodes)
Ask pt to drink water and observe for any masses moving on swallowing
Ask pt to protrude their tongue and look for movement of masses (no movement = thyroid gland mass, upward movement = cyst)

Question 6

What do you asses on palpation of neck?

Answer 6

1. Start at thyroid cartilage
2. Move down to cricoid cartilage
3. Then to isthmus of thyroid
4. Palpate isthmus and each thyroid lobe
5. Ask patient to protrude tongue (cyst)
6. Ask pt to swallow water (asymmetrical elevation –> unilateral mass)
7. Palpate lymph nodes
8. Assess for tracheal deviation

Question 7

What do you assess on percussion?

Answer 7

To detect any retrosternal dullness (large inferior goitre)

Question 8

What do you assess on auscultation?

Answer 8

Thyroid bruit (increased vascularity caused by Graves')
Pt must hold breath

Question 9

What special tests should you perform?

Answer 9

Reflexes (hypo in hypo)
Inspect for pre-tibial myxoedema (Graves’)
Assess for proximal myopathy (pt must stand with arms crossed)