Thyroid Status Examination Flashcards
Introduction
Wash hands, PPE Introduce yourself Patient DOB, ID Explanation - Repositioning -on chair -expose neck and upper sternum -any pain or questions?
General inspection
- what are you looking for
- patient
- objects
Patient Weight -weight loss => hyper -weight gain => hypo Behaviour -anxiety, hyperactivity, SNS => hyper -low mood => hypo Clothing inappropriate for temperature -heat intolerance => hyper -cold intolerance => hypo Hoarse voice - compression of larynx from thyroid enlargement?
Mobility aids - proximal myopathy from hyper
Prescription - levothyroxine, carbimazole
Hand inspection
- what are you looking for
- how would you assess for thyroid related pathology
Inspection
Thyroid acropachy (clubbing, soft tissue swelling of extremities) - Graves
Onycholysis - hyperthyroidism
Palmar erythema - hyper, CLD, pregnancy
Peripheral tremor - SNS overactivity
-hold arms out, place paper on hands to assess for tremor
Radial pulse
Brady - hypo, normal, AV block, medication
Tachy - hyper, anxiety, SVT, hypovolemic?
AF - hyper
Face inspection
- what are we looking for?
- what is this a sign of?
Dry skin - hypo
Sweating - hyper
Loss of outer 1/3 - hypo
Eyes
SNS lid retraction - sclera visible between upper lid and corneal limbus (outline of iris) - Graves, hyper
Exopthalmos - Graves
-inspect from front, side, above
-edema and lymphocytic infiltration of orbital far, connective tissue, extraocular muscles
Eye inflammation - Graves
-increased risk of drying out
Eye movements
- what are you assessing for
- how would you do this
Follow H with eyes only
Assess for restricted eye mv
Ask patient to report pain, double vision
-all caused by Graves (lymphocytic infiltration of orbital fat, connective tissue, extraocular muscles)
Lid lag
- what are you assessing for
- how would you do this
Delay in descent of upper eyelid in relation to eyeball when looking down - Graves
Hold finger superiorly, ask patient to follow it with their eyes only
Move finger down
-upper eyelid movement will be seen after eye mv
-LOOK FOR SCLERA BETWEEN CORNEAL LIMBUS AND UPPER LID
Thyroid inspection
- where are you looking
- what are you looking for
Neck midline
-masses - goitre
-scars - past thyroidectomy
NORMAL GLAND SHOULD NOT BE VISIBLE
Swallow water
- Thyroid masses => move up on swallow
- LNs => v little mv
- invasive thyroid malignancy => tethered to surrounding tissue, v little mv
Tongue protrusion
- Thyroglossal cysts => mv up
- thyroid masses, LN => no mv
Thyroid palpation
Stand behind patient
Chin tilt down to relax neck muscles
Middle 3 fingers of both hands along neck midline
Locate Adam’s apple and cricoid cartilage
Palpate isthmus
Palpate lobes as patient swallows water => symmetrical elevation is normal
-asymmetrical => thyroid mass?
Palpate lobes as patient sticks out tongue => thyroglossal cyst rises
Size - enlarged?
Symmetry - asymmetry => nodule, malignancy?
Consistency - widespread irregular => multinodular goitre?
Mass - nodules, malignancy?
-position, shape, consistency, moblity?
Thrills - hypervascularity from Graves
Types of possible pathology in the thyroid
Thyroglossal cyst - persistence of thyroglossal duct
-tongue attached here => cyst rises on tongue protrusion
Diffuse goitre - whole thyroid enlarged due to hyperplasia
Uninodular goitre - single thyroid nodule (active or benign)
Multinodular goitre - active or benign
Lymph node palpation
-what are we assessing for
Local lymphadenopathy => metastasis of primary thyroid cancer
-cervical LN
NO PIANO PLAYING
Tracheal examination
-what are we assessing for
Tracheal deviation from large goitre
Sternum examination
-what are we assessing for
Percuss sternum from sternal notch downwards
-large thyroid mass extending behind manubrium
Auscultation of thyroid
-what are we assessing for
Auscultate each lobe for bruit with bell => increased vascularity in Graves
Reflexes
- what are we assessing for
- how would we do this
Hyporeflexia - hypothyroid
Biceps reflex
Leg assessment
- what are we assessing for
- how would we do this
Pretibial myxodema - excess GAGs in dermis => waxy, discoloured induration on pretibial region (Graves)
Proximal myopathy - complication of multinodular goitres, Graves => wasted proximal muscles cause difficulty in standing from sitting
Ask patient to stand from sitting with their arms crossed
Inability to stand => proximal muscle weakness
