Thyroid Examination Flashcards
What is lingual thyroid
Where the thyroid does not descend down the neck during development.
Which arteries run either side of the thyroid
Carotid arteries
What are the three presentations of thyroid disease
- lump in neck or mass effect
- hyperthryoidism
- hypothyroidism
How does hypothyroidism normally present
Goitre
Questions when someone presents with lump in neck
When did it start?
How quickly is it changing?
Any family history?
Is there any pain?
What questions would you ask about the pain in the neck
Just in the enlargement?
Whole region of gland?
Slow onset or sudden?
What questions to ask when someone has goitre?
Difficulty breathing?
Difficulty swallowing?
Pain?
Incidental finding on CT/CXR
Neck pain
Neck Swelling
High temperature
Thyroiditis
Initial treatment for overactive thyroid
Beta blockers
Are there any contraindications for starting someone on beta blockers before you have confirmed hyperthryoidism
No
Symptoms of hypothyroidism
Tiredness Weight gain Lethargy Lack of concentration Depression Cold intolerance Headahces Menorrhagia Constipation Dry skin Hoarse voice
Questions for hypothyroidism
How long have symptoms been present?
Speed of onset?
Medication?
Family history of AI
Which medications are associated with hypothyroidism
Amiodarone and lithium
Which AI conditions are most strongly associated with hypothyroidism
Thyroid and B12 deficiency
Primary causes of hypothyroidism
Dyshormogenesis Iodine deficiency Autoimmunity Post radioactive iodine Post thyroidectomy
Secondary causes of hypothyroidism
Pituitary tumours
Pituitary granulomas
Empty sella
Tertiary causes of hypothyroidism
Isolated TRH deficiency
Hypothalamic disorders
Who gets hypothyroidism screening
T1DM
Pernicious anaemia
Addisons
Vitiligo
Hyperthryoidism symptoms
Weight loss • Sweating • Palpitations (AF in more elderly) • Tremor • Preference for cool environment • Anxiety • Lack of concentration • Diarrhoea/loose stool • Oligo/amenorrhoea • Muscle weakness
Which eye state is a sign of all hypethryoidism types
Lid lag
Questions for hyperthryoidism
How long have symptoms been present?
Speed of onset?
Medication?
Family history?
Common causes of hyperthyroidism
AI disease
(Graves disease, postpartum thryoiditis)
Toxic nodular goitre
Toxic adenoma
Rare causes of hyperthryoidism
Amiodarone
De Quervains
Thyrotroph adenoma
hCG hyperthryoidism
Graves specific features
Thryoid eye disease
Thyroid acropachy
Pre tibial myxoedema
Thyroid eye disease
Exopthalmos
Thyroid acropachy
Pretibial myxoedema
What are the first things you do in an examination
Consent
Wash hands
Ask about pain
What is included in the general exam
Can they walk?
Face patient
General appearance
Examination of hands
Inspect hands
- sweating
- palmar erythema
- clubbing
- brittle nails
- pulse
- tremor
How do you examine the tremor
Put a sheet of A4 on their hands
How do you look for the thryoid
Inspect neck
Patient drinks, does it move?
Ask patient to project tongue and open mouth
What does a midline cyst that moves up suggest
Thyroglossal cyst
How do you palpate the mass
Palpate thryoid
Palpate trachea
Ask patient to drink water, palpate the movement
What are you examining about a mass
Size Shape Surface Consistency -soft, firm, hand fixed? above and below? any lymph enlargement?
How do you examine the thyroid with your hands
Flex at the MCP
How do you examine exopthalmos
Look at them from above
How do you examine the eys
Evidence of thryoid disease Conjuctival oedema Eye movements Acuity and fundoscopy Check for lid lag
How do you check for lid lag
Ask patient patient to follow your hand up as you look from the side then follow it down
When you auscultate and get a bruit what does that suggest
Graves as hypervascular
Does graves disease have to have hyperthryoidism
No, they can present with eye signs only
Apart from the head and neck where do you examine
The feet and shins for pretibial myxoedema which is a sign of graves
What does proximal muscle weakness suggest
Could be hyperthyroidism or hypothryoidism
How do you finish a thyroid exam
Check ankle or brachial reflexes
Thank the patient
Hypothyroidism reflexes
Slow relaxing reflex
Hyperthyroidism reflexes
Brisk
Steps of thryoid exam
- 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
