Thyroid Examination Flashcards
What should you inspect on a thyroid examination?
General appearance, hands, tremor, pulse, forearm, eyes, neck (normal, swallowing water, protruding tongue), back of tongue
What are you inspecting on general appearance?
Build, inappropriate clothing, restlessness, confusion, quality of skin and hair
What do you inspect on their hands?
Temperature, sweating, palmar erythema, clubbing (thyroid acropachy), brittle nails, onycholysis. Tremor
What are you looking for in the patients pulse?
Bradycardia, tachycardia, AF
What are you inspecting the forearm for?
Muscle wasting
What are you inspecting the eyes for?
Exophthalmos, proptosis, chemosis, bloodshot eyes, lid oedema, lid retraction, lid lag, eye movements, visual acuity
Why do you inspect for exophthalmos?
This is proptosis in association with hyperthyroidism. It may lead to inability to close the lids properly. This may cause sight-threatening exposure keratopathy.
How do you inspect for lid lag?
Ask the patient to look down. Delayed downward movement of the eyelids on downgaze indicates lid lag.
Why do you check eye movements?
There may be myopathy of the extraocular muscles. Also, diplopia can result from restricted ocular mobility, initially involving the inferior rectus muscles
Why do you do fundoscopy?
Proptosis may stretch the optic nerve. The optic disc often appears normal but may be atrophic in long-standing cases with irreversible loss of vision
What does it mean if the thyroid mass moved on swallowing?
A thyroid mass
What does it mean if the thyroid mass moves upwards on tongue protrusion ?
It indicates a thyroglossal cyst
Why do you inspect the back of the tongue?
A lingual thyroid
Why do you palpate the trachea?
To see if it’s central
What do you check when palpating the anterior neck?
Size, site, is it diffusely enlarged? Hard or soft? Smooth or nodular? Is the mass fixed or movable? Can you feel above and below the mass? Feel the mass if it moves?
What do you palpate in a thyroid examination?
Trachea, the anterior neck, cervical lymph nodes
What do you percuss in a thyroid exam?
The upper sternum
Why do you percuss the upper sternum?
For retrosternal extension of the goitre
How do you auscultate in a thyroid examination?
Ask the patient to hold their breath. Auscultate with the bell of the stethoscope over the lobes of the thyroid gland for bruits.
How do you finish a thyroid exam?
Check the ankle reflexes, inspect for pretibial myxoedema
What might you find on examining the ankle reflexes?
There may be normally brisk ankle reflexes which are slow to return to the resting state (delayed relaxation) in hypothyroidism
