Thyroid Examination

Question 1

What is lingual thyroid

Answer 1

Where the thyroid does not descend down the neck during development.

Question 2

Which arteries run either side of the thyroid

Answer 2

Carotid arteries

Question 3

What are the three presentations of thyroid disease

Answer 3

• lump in neck or mass effect
• hyperthryoidism
• hypothyroidism

Question 4

How does hypothyroidism normally present

Answer 4

Goitre

Question 5

Questions when someone presents with lump in neck

Answer 5

When did it start?
How quickly is it changing?
Any family history?
Is there any pain?

Question 6

What questions would you ask about the pain in the neck

Answer 6

Just in the enlargement?
Whole region of gland?
Slow onset or sudden?

Question 7

What questions to ask when someone has goitre?

Answer 7

Difficulty breathing?
Difficulty swallowing?
Pain?
Incidental finding on CT/CXR

Question 8

Neck pain
Neck Swelling
High temperature

Answer 8

Thyroiditis

Question 9

Initial treatment for overactive thyroid

Answer 9

Beta blockers

Question 10

Are there any contraindications for starting someone on beta blockers before you have confirmed hyperthryoidism

Answer 10

No

Question 11

Symptoms of hypothyroidism

Answer 11

Tiredness
Weight gain
Lethargy
Lack of concentration
Depression
Cold intolerance
Headahces
Menorrhagia
Constipation
Dry skin
Hoarse voice

Question 12

Questions for hypothyroidism

Answer 12

How long have symptoms been present?
Speed of onset?
Medication?
Family history of AI

Question 13

Which medications are associated with hypothyroidism

Answer 13

Amiodarone and lithium

Question 14

Which AI conditions are most strongly associated with hypothyroidism

Answer 14

Thyroid and B12 deficiency

Question 15

Primary causes of hypothyroidism

Answer 15

Dyshormogenesis
Iodine deficiency
Autoimmunity
Post radioactive iodine
Post thyroidectomy

Question 16

Secondary causes of hypothyroidism

Answer 16

Pituitary tumours
Pituitary granulomas
Empty sella

Question 17

Tertiary causes of hypothyroidism

Answer 17

Isolated TRH deficiency

Hypothalamic disorders

Question 18

Who gets hypothyroidism screening

Answer 18

T1DM
Pernicious anaemia
Addisons
Vitiligo

Question 19

Hyperthryoidism symptoms

Answer 19

Weight loss 
• Sweating
• Palpitations (AF in more elderly)
• Tremor
• Preference for cool environment
• Anxiety
• Lack of concentration
• Diarrhoea/loose stool
• Oligo/amenorrhoea
• Muscle weakness

Question 20

Which eye state is a sign of all hypethryoidism types

Answer 20

Lid lag

Question 21

Questions for hyperthryoidism

Answer 21

How long have symptoms been present?
Speed of onset?
Medication?
Family history?

Question 22

Common causes of hyperthyroidism

Answer 22

AI disease
(Graves disease, postpartum thryoiditis)
Toxic nodular goitre
Toxic adenoma

Question 23

Rare causes of hyperthryoidism

Answer 23

Amiodarone
De Quervains
Thyrotroph adenoma
hCG hyperthryoidism

Question 24

Graves specific features

Answer 24

Thryoid eye disease
Thyroid acropachy
Pre tibial myxoedema

Question 25

Thyroid eye disease

Answer 25

Exopthalmos Thyroid acropachy Pretibial myxoedema

Question 26

What are the first things you do in an examination

Answer 26

Consent Wash hands Ask about pain

Question 27

What is included in the general exam

Answer 27

Can they walk? Face patient General appearance

Question 28

Examination of hands

Answer 28

Inspect hands - sweating - palmar erythema - clubbing - brittle nails - pulse - tremor

Question 29

How do you examine the tremor

Answer 29

Put a sheet of A4 on their hands

Question 30

How do you look for the thryoid

Answer 30

Inspect neck Patient drinks, does it move? Ask patient to project tongue and open mouth

Question 31

What does a midline cyst that moves up suggest

Answer 31

Thyroglossal cyst

Question 32

How do you palpate the mass

Answer 32

Palpate thryoid Palpate trachea Ask patient to drink water, palpate the movement

Question 33

What are you examining about a mass

Answer 33

``` Size Shape Surface Consistency -soft, firm, hand fixed? above and below? any lymph enlargement? ```

Question 34

How do you examine the thyroid with your hands

Answer 34

Flex at the MCP

Question 35

How do you examine exopthalmos

Answer 35

Look at them from above

Question 36

How do you examine the eys

Answer 36

``` Evidence of thryoid disease Conjuctival oedema Eye movements Acuity and fundoscopy Check for lid lag ```

Question 37

How do you check for lid lag

Answer 37

Ask patient patient to follow your hand up as you look from the side then follow it down

Question 38

When you auscultate and get a bruit what does that suggest

Answer 38

Graves as hypervascular

Question 39

Does graves disease have to have hyperthryoidism

Answer 39

No, they can present with eye signs only

Question 40

Apart from the head and neck where do you examine

Answer 40

The feet and shins for pretibial myxoedema which is a sign of graves

Question 41

What does proximal muscle weakness suggest

Answer 41

Could be hyperthyroidism or hypothryoidism

Question 42

How do you finish a thyroid exam

Answer 42

Check ankle or brachial reflexes | Thank the patient

Question 43

Hypothyroidism reflexes

Answer 43

Slow relaxing reflex

Question 44

Hyperthyroidism reflexes

Answer 44

Brisk

Question 45

Steps of thryoid exam

Answer 45

- introduce - wash hands - ask for pain - inspect - look at hands and feel - examine pulse - look for tremor - full eye exam (H and lid lag) - neck (swallow then tongue) - palpate patient from behind - auscultate - assess proximal weakness - inspect shins - thank the patient