Thyroid Exam

Question 1

Introduction?

Answer 1

1 - Introduce yourself
2 - Confirm patient’s details
3 - Explain the procedure
4 - Gain Consent

Question 2

Pre-procedure?

Answer 2

Wash hands

Position yourself behind the patient

Question 3

First step?

Answer 3

Inspection (look)

HANDS

• Is the patient agitated?
• Hands (tremors?) - USE A PAPER SHEET
• —-Dry Skin or palmar erythema
• —-Sweat

Question 4

Second step?

Answer 4

Palpation (feel)

-Pulse (rhythm, rate)

Question 5

Third step?

Answer 5

Inspect the FACE and EYES

-Look for sweating, exophtalmos (position yourself on the side)

Question 6

Fourth step?

Answer 6

MOVE THE EYES (H test and lid lag) - restriction of eye movements

Question 7

Fifth step

Answer 7

NECK

(Inspect - masses? Goitres?)

Move

• Ask the patient to drink some water
• Protrude the tongue (thryroglossal cyst)

Palpation (below the CRICOID cartilage)
1- Thyroid
(whilst palpating –> ask the patient to drink some water again and protrude their tongue)
2 - Lymph nodes

Tracheal deviation

Question 8

Sixth step?

Answer 8

Percuss (intra-thoracic goitre) and auscultate (bruits in Graves’ disease)

Question 9

Final step?

Answer 9

Special tests

• Upper limp reflexes
• Inspect pre-tibial edema
• Proximal miopathy (ask the patient to lift from the chair w/o using their arms

Question 10

Summarise findings

Answer 10

“Today I’ve examined Simon, a 22 yeard-old male.
On general inspection, he had a fine tremor with outstretched hands, but there were no other perypheral stigmata of thyroid diseases. No evidence of goitres or thyroid eye disease