Thyroid Examination Flashcards
Anatomy of thyroid
Butterfly shaped gland
Isthmus running through middle
Closely related to carotid arteries
Sits near cricothyroid membrane
What does the thyroid gland sit close to
The trachea
Thyroid is vascular
What does thyroid contain?
Colloid filled follicles with thyroid filled hormones
Follicular and parafollicular cells
3 main presentations of Thyroid disease
- Lump in neck or mass effect
- unilateral mass
- bilateral mass - enlarged thyroid = goitre
- symmetrical or asymmetrical - Hypo or Hyperthyroidism
- Graves specific features
What does hyperthyroidism and hypothyroidism usually present with?
Hyper = goitre
Hypo - often no goitre
Questions for lump in neck
When did it start?
How quickly is it changing if at all?
Any FH?
Any pain?
Slow or sudden onset
Sudden onset could be due to bleed into thyroid nodule
Slow could be due to malignancy
Lump in neck - history
Diffculty in breathing and swallowing?
Pain - thyroiditis and cancer
Incidental finding on CT/ TXR
Where is a thyroglossal cyst found?
Found just above normal thyroid position?
Symptoms of hypothyroidism?
Tired
Weight gain
Lethargy
Bad concentration
Depression
Cold intolerance
Headaches
Menorrhagia
Constipation
Dry skin
Hoarse voice
Pallor/ lightness of skin (Peaches and cream)
Questions to ask for hypothyroidism and hyper?
How long have symptoms been present?
Speed of onset?
Previous treatment for overactive thryoid?
Previous medication - amiodarone (causes both) and lithium
FH of AI disease - thyroid and B12 deficiency, vitiligo Type 1, addisons
Loss of eyebrow hair - hypo only
Primary causes of hypothyroidism?
Dyshormonogenesis
Iodine deficiency
AI
Post radioactive iodine
Post thyroidectomy
Secondary and teriary causes of hypothyroidism
Pituitary tumours
Pituitary granulomas
Empty sella
Isolated TRH deficiency
Hypothalamic disorders
What is the presentation of hypothyroidism?
Symptoms often vague and insidious
Screening in assosicated condiitions - Type 1, pernicious anaemia, addisons, vitiligo,
Symptoms of hyperthyroidism
Weight loss
Sweating
Palpitations AF
Tremor
Anxiety
Lack of conc
Diarrhoea loose stool
Amenorrhoea
Muscle weakness
Causes of hyperthyroidism
Common:
AI - Graves, postpartum thyroiditis
Toxic nodular goitre
Toxic adenoma
Rare@
Amiodarone induced
De Quervains
Thyrotroph adenoma
hCG hyperthyroidism
- hydatidiform mole
- choriocarcinoma
Graves specific features
Proptosis (eyes)/ exopthalmos - bilateral or unilateral
Pain
Grittiness
Change in vision especially colour
Thyroid acropachy - changes in nail, look like clubbing
Pre tibial myxoedema - Skin changes
Examination 1 - general
Clean hands - wash or alcohol
Check wheter any pain or tenderness in hands or neck
Patient seated
Face patient
General appearance - calm? restless? confused/ agitated?
Examination 2. hands inspection
Sweating - hyper
Palmar erythema
Thyroid acropachy - graves
Brittle nails - hypothyroid - Fe def
Pulse - bradycardia, tachycardia or AF
Tremor - hands outstretched
Examination 3. Thyroid
Inspect neck - masses, welling, scars
Ask patient to take water into mouth and hold it and then swallow it - does mass move up when swallowing
Ask patient to project tongue - if midline mass moves up - thyroglossal cyst
Ask patient to open mouth - lingual thyroid back of tongue
From behind patient:
Palpate thyroid - ask if theres any pain or discomfort
Palpate trachea - deviated
Ask patient to take water into mouth - hold then swallow whilst palpating hands and fingers still
If theres a thyroid mass how do you evaluate?
Check its:
Size
Shape
Surface
Consistency
Hard soft firm?
Fixed to skin?
Can you get above or below it?
Any lymph node enlargement?
Thyroid examination 4
Examine for exopthalmos
Auscultation - ? Bruit - with patient briefly holding breath
Bruit - sound made through rapid blood flow through part of body - found in thyroid or neck vessels - swishing sounds indicative of bruit
Examination of eyes
Evidence of thyroid eyes disease?
Conjunctival oedema
Eye movements - ? diplopia
Acuity and fundoscopy
Check for lid lag - a sign of thyrotoxicosis - eye lids lagging behind rest of eye - hyperthyroidism in any form
Lid retraction - any form hyperthyroidism
