Thyroid Examination Flashcards
What would you look for on GI of a thyroid patient?
swelling, hoarseness, stridor (goiter), sweating, anxious/agitated, appropriately dressed, weight (wasting, puffy, overweight)
GI of HYPERTHYROID Patient would see:
Anxious Sweating (inappropriate clothing for weather) Weight loss Facial vein engorgement Hoarseness Eye signs
GI of HYPOTHYROID Patient would see:
Mental & physical sluggishness Cold Coarse, pale skin- dry hair, thick skinn Oedematous, tired/sluggish/weak Deep voice Yellowish ting to skin
HANDS : hyper vs HYPO
HYPERTHYROID Sweating Tremor Palmar erythema Graves acropachy (clubbing)* Onycholysis*
HYPOTHYROID Clammy skin Peripheral cyanosis Anemia of palmar creases (iron deficiency) Carpal tunnel syndrome (tinnel’s sign)
Arms : hyper vs Hypo
HYPER Pulse: tachycardia, (ii) atrial fibrillation Reflexes: brisk (hyperreflexia) Proximal myopathy Pemberton’s sign
HYPO
Pulse: bradycardia (decreased CO)
Reflexes: normal contraction, slow relaxation
Proximal myopathy
What is pembertons sign? What does it test for?
Pemberton’s sign - ask the patient to lift both arms as high as possible.
watch the patient’s face for signs of congestion - plethora - and cyanosis. Respiratory distress and inspiratory stridor may occur. Venous congestion may be apparent as distension of the neck veins.
listen for stridor whilst the patient takes in a deep breath.
Hair changes in hypothyroidism
Brittle hair
Alopecia
Face/eyes hyperthyroidism
Goitre, bruit Lid lag, Lid retraction Jaundice Proptosis* Conjunctival erythema* Periorbital oedema* Corneal ulceration* Visual acuity* Colour vision* Dipolopia* Exophthalmos (abnormal eyeball protrusion)
Face eyes/ hypothyroid
Coarse and thin hair
Loss of eyebrows, deep voice. Deafness
Periorbital oedema
Xanthelasma
White sclera despite yellowish skin in hypercarotenemia
Muscular signs: hyperthyroid
Proximal muscle wasting
Proximal Myopathy
Muscular signs: hypothyroid
Myotonia
Muscular hypertrophy
Proximal myopathy (slow to relax after contraction)
Slow relaxing reflexes
In an EXAMINATION what do you look for i the neck
INSPECTION • Dilated veins • Diffuse or nodular enlargement • Erythema • Scars • Movement with swallowing
PALPATION
PALPATION • Shape • Consistency (nodule/s, regular/irregular, symmetrical) • Tenderness • Thrills • Mobility – with swallowing again
Other
OTHER • If there is a goiter, percuss for retrosternal extension • Auscultate for a bruit * • Palpate surrounding lymph nodes • JVP
Outline some differentials for a neck lump
- think LOCATION
- eg. lymph node enlargement?
- eg. Widespread
- eg. midline
- eg. Anterior triangle
- eg. posterior triangle
Lymph node enlargement – infection, neoplastic
Widespread – sebaceous cysts, lipoma
Midline – thyroid nodule, thyroglossal cyst (moves up when tongue protruded), dermoid cyst
Anterior triangle – carotid body tumour, carotid aneurysm, lateral thyroid tumour
Posterior triangle – pancoast tumour
