Thyroid Exam

Question 1

List the sequence of the thyroid exam

Answer 1

Neck exposure

• Appropriate dress for the temperature

General Inspection

• Weight (how their clothes fit) - ?Tired/fatigued
• ?Anxious
• Facial myoedema
• Facial hairloss, eyebrow loss in out 1/3
• Dyspneic, stridor (goiter)

Hands

• Thyroid acropachy - Palmar erythema - Sweaty

Pulse
- ?Tachy, AF (in hyper)

Arms

• Biceps reflexes
• Proximal myopathy (shoulder adduction)

Papers test for tremor

Neck Inspection

• Scar!
• Masses
• Nodules
• Watch patient swallow water
• Thyroid masses will move with swallowing
• A thyroglossal cyst will move poking of tongue

Pemberton’s sign - hands up

Palpation

• Thyroid gland!
• Nodes, 9 places - Trachea

Percussion
- Down the sternum - both clavicles

Auscultation
- Thyroid bruit

Look for proptosis
- From the side, behind and above

Look for eye signs

• Test for lid lag
• Eye movements (?pain or double vision)

Legs

• Pretibia myedema - Proximal myopathy - Ankle reflex

Question 2

What are 5 eye signs of thyrotoxicosis?

Answer 2

Exopthalmos

Lid lag

Chemosis

Opthalmoplegia

Scleral showing