Thyroid Exam Flashcards
General inspection from end of bed
- comfortable and calm
- hyperactive (agitation, anxiety, fidgety in hyperthyroidism)
- inappropriately dressed for weather (too few/too many clothes)
- over/ underweight
- is voice croaky/horse?
Inspection of hands
- sweaty/clammy in hyperthyroidism
- dry skin in hypothyroidism
- palmar erythema in hyperthyroidism
- thyroid acropachy due to phalanges overgrowth in Graves’ disease: clubbing, digital swelling, periosteal new bone
- oncholysis: nail is separated from nail bed
Inspection of arms
TREMOR:
- ask pt to place arms in front of them
- place piece of paper across back of hands
Ask pt to raise both hands above head to observer for facial flushing (Pemberton’s sign)
Take radial pulse on R side: rate and rhythm (AF in thyrotoxicosis, tachycardia in hyperthyroidism, bradycardia in hypothyroidism)
General inspection of head
- dry skin in hypothyroidism
- sweating in hyperthyroidism
- loss of outer third of eyebrows in hypothyroidism
Inspection of eyes
- Exophthalmos (ant displacement of eye out of orbit)
- eye movements (H shape. Look for restriction of movement and ask pt to report pain/double vision)
- lid lag (hold finger high and ask it to follow it with their eyes whilst keeping head still. Move finger down quickly. Observe upper eyelids)
Inspection of thyroid
- skin changes (erythema)
- scars (previous thyroidectomy)
- obvious masses or swellings
- get pt to hold water in mouth and then swallow (masses in thyroid will move with swallowing and so will thyroglossal cysts, lymph nodes will move very little)
- get pt to stick out tongue, look into mouth for undescended lingual thyroid
Palpation of thyroid
- pain?
- stand behind pt and palpate thyroid
- place 3 fingers along midline of neck below chin
- locate upper edge of thyroid cartilage
- move down to feel cricoid cartilage
- palpate thyroid isthmus
- ask of to swallow some water
- feel for symmetrical elevation of thyroid loves (asymmetrical elevation = unilateral thyroid mass)
- ask pt to protrude tongue once more (thyroglossal cyst will rise during tongue protrusion)
What should you assess about the thyroid?
- size
- symmetry
- consistency (smooth or nodular: multinodular goitre)
- masses
- palpable thrill (inc vascular it’s in thyrotoxicosis)
What else should you palpate for?
- lymph nodes
- tracheal deviation (not any deviation that could be caused by large thyroid mass)
What should you percuss?
Percussion of sternum
Percuss downwards from sternal notch (retro sternal thyroid tissue)
Where should you auscultate?
Listen over each line while pt is holding breath
Bruits would suggest inc vascularity in Graves
What are the extras?
- inspect shins for Pretoria’s myxoedema (Graves)
- proximal myopathy: ask pt to stand from sitting position with arms crossed. Inability = muscle wasting (hyperthyroidism)
- ankle reflexes (hyporeflexia = hypothyroidism)
How to complete exam?
- full history exam
- basic obs
- thyroid function tests
- ECG if irregular pulse
- US of thyroid if pathology was indicated
