Thyroid Exam Flashcards
How do you explain and gain consent for a thyroid exam?
“I’ve been asked to do an examination of your thyroid which is a gland that sits in your neck. it will involved me having a look at your hands face and neck, asking you to sip some water and I will also feel your neck. You will have to have your neck exposed and the examiner will act as the chaperone today - Is this ok?”
- are you in any pain at all?
What is the general layout of the thyroid exam?
1) WIPE
2) General inspection (patient and bedside)
3) inspect HANDS
4) inspect FACE
5) inspect EYES
6) inspect NECK
7) palpate neck
8) palpate lymphnodes
9) tracheal deviation + percuss
10) bruits?
11) reflexes
12) pretibial myxoedema
13) proximal myopathy
What do you look for on general inspection of the patient and bedside?
1) Patient
- alert, comfortable at rest
- prominent goitre
- appropriate clothing
- normal bodyhabitus (not over or underweight)
- hyperactive? / restless? / fidgety?
2) bedside
- excessive food
- clothing
- thyroid medications such as levothyroxine and carbimazole
What to you look for on inspection of the hands?
- thyroid acropachy
- onycholysis
- sweaty or dry skin
- palmar erythema
- fine tremor
- Pulse - tachy? brady? irregular (AF)?
What do you look for on inspection of the face?
loss of outer 3rd of eyebroe
sweating
dry skin
What do you look for on inspection of the eyes?
- chemosis (conjuctival swelling)
- periorbital oedema / erythema
- lid retraction
- assess from side and above for exophthalmos
- assess eye movements (cranial nerves 3,4,6)
- lid lag
What do you look for on inspection of the neck?
- look from front and side for
- scars, erythema, swelling
- distended neck veins
- ask patient to sip water, hold then swallow
- look for movement of the thyroid gland (normal)
- ask patient to protrude tongue
- look of movement (thyroglossal cyst)
what do you feel for on palpation of the neck?
1) temperature
2) palpate when patient swallows ( movement normal for thyroid gland)
3) palpate when pt protrudes tongue (movement will only be felt for thyroglossal cyst)
4) palpate L/R lobes and isthmus
- asses size, symmetry, consistency, masses, thrills
What do you feel for when palpating the lymph nodes?
- submental
- submandbibular
- tonsilar
- parotid
- peri auricular
- post auricular
- anterior chain
- supraclavicular
- posterior chain
- occipital
How do you assess for retrosternal goitre?
percuss from the sternal notch down - retrosternal dullness may indicate a large thyroid mass extending down posterior to manubrium.
How do you assess for proximal myopathy?
As the patient to cross arms and stand.
In proximal myopathy they won’t be able to do this.
What are the differentials for smooth / diffuse thyroid swelling?
- hashimoto’s disease (hyperthyroid)
- Grave’s disease (hypothyroid)
- Iodine deficiency (hypothyroid)
What are the differentials for a solitary nodule in the thyroid?
- cyst
- colloid nodule
- adenoma
- carcinoma
- dominant nodule multinodular goitre
What are the differentials for a multiple nodule thyroid swelling?
- multiple cyst
- multiple nodular goitre
What are the treatments for thyrotoxicosis?
- carbimazole + beta blocker
- Radioiodine
- surgert
