Thyroid Status and Gland Examination Flashcards
Components of examination
Introduction - WIPER QQ
Questions relating to thyroid status
Examination relating to thyroid status - general, hands, upper limbs, face, eyes, chest, abdo, lower limb
Examination of thyroid gland and related structures
Conclusion
Questions about thyroid status
Have there been changes in your:
Weight
⬆️loss
⬇️gain
Appetite
⬆️increased
⬇️decreased
Bowel habit
⬆️loose
⬇️constipated
Energy levels
⬆️fatigue
⬇️fatigue
Exercise tolerance - how much physical activity you can do before feeling tired
⬆️SOB
⬇️SOB, palpitations
Temperature tolerance - how hot or cold you generally feel
⬆️hot
⬇️cold
Skin and hair
⬆️more sweaty
⬇️hair loss, dry skin
Mood
⬆️anxious
⬇️depressed
Menstrual pattern
⬆️reduced/absent
⬇️heavy
FHx
⬆️Graves
⬇️Underactive thyroid
General observations
-appearance, behaviour
-voice
Appearance and behaviour
⬆️anxious, agitated, underweight
⬇️slow, lethargic, confused, overweight
Voice
⬆️rapid speech
⬇️slow, deep, hoarse
Hands and nails
-how would you test for findings
-what are you looking for
Wrist and upper limb
-how would you test for findings
-what are you looking for
Inspect hands and nails
Hold out arms for tremor
⬆️warm sweaty palms, erythema, onycholysis, tremor
Graves specific
Acropachy - clubbing, finger swelling, periosteal reaction
⬇️dry palms
Wrist - pulse check, tenderness?
⬆️irregular, tachy
⬇️irregular, Brady
Carpal tunnel tenderness - carpal tunnel syndrome
Chicken wings, don’t let me move your arms down
⬆️proximal weakness
⬇️
Face
-what are you looking for
Colour, eyebrows
⬆️red, sweaty
⬇️loss, thinning of outer 1/3d, dull puffy face with dry skin, periorbital edema
Eyes
-how would you test for findings
Inspection
⬆️lid retraction - sclera between iris and eyelid visible
Graves specific
Chemosis (swelling of conjunctiva) leading to puffy eyelids - inspect from front
Periorbital edema - inspect from front
Exopthalmos (eyeball protrudes beyond supraorbital ridge) - inspect from side
⬇️Periorbital edema
Graves specific
Lid lag - hold finger horizontally above patient’s head, 0.5m in front of face. Ask them to follow it with their eyes, moving it down vertically quickly
⬆️sclera above iris visible before eyelid catches up
⬇️
Graves specific
Opthalmoplegia - eye movements following H finger
⬆️double vision
⬇️
Chest and abdo
-what are we looking for
Assess for pleural effusion, pericardial effusion, heart failure
-inspect - high JVP
-palpate - displaced apex beat
-percuss - stony dull
-auscultation - reduced breath sounds, muffled heart sounds
Assess for ascities
-shufting dullness
ALL ⬆️⬇️
Lower limb
-what are we looking for
-how do we assess for it
Inspection - looks at shins
⬆️Graves specific - pretibial myxedema
⬇️generalised myxedema
Plaques of thick scaly, swollen skin
Knee reflexes
⬆️brisk
⬇️slow relaxation
Examination of thyroid gland
Inspection
Inspection for
-goitre
-scars
-pulsation
-obvious lymphadenopathy
Lump => stick tongue out
-thyroglossal cyst elevates
Swallow water => swelling rises on swallowing
-enlarged thyroid
Examination of thyroid gland
Palpation
Front - tracheal deviation
Behind - ask patient to drop their chin
Palpate 2 lobes and isthmus with index and middle finger
Swallow water whilst palpating
Goitre?
Site - anterior or posterior triangle?
Size - diamter in cm
Consistency - hard or soft
Shape and surface - diffuse, lobar, nodular (number of nodules)
Mobility - with finger and thumb, horizontal and vertical
Tender - diffuse or localised
Margins - well demarcated or ill defined
Cervical LN
Examination of thyroid
Percussion
Auscultate
Percuss for retrosternal extension from sternal notch => downwards
Goitre is dull
Auscultate goitre for bruit
⬆️increased vascularity
Conclusion
Further steps
History
Vital signs
ECG - further assessment of tachy/brady/arrythmias
CXR - HF
Bloods
TFTs
