Thyroid Exam
The Thyroid Exam
Vital Signs
- HR (brady/tachycardia)
- BP (wide pulse pressure)
Inspection
- medial and inferior, isthmus crosses trachea between 2nd and 4th tracheal ring
- each lobe should be no larger than the distal phalanges of the patient’s thumb
- obliteration of the medial borders of SCM muscles
- have the patient slightly extend their neck and to swallow a sip of water
- assess for a ≥ 2 mm increase in the horizon of the lateral view of the neck over the area of the thyroid isthmus, especially if it moves upwards during swallowing
- assess for asymmetry, masses, erythema, deviation of the trachea
Palpation
- cervical nodes, tracheal deviation
- CAROTID PULSE - absence indicates malignant thyromegaly (Berry’s Sign)
- Tenderness
- start from under the suprasternal notch, medial the SCM
Anterior Approach
- face the patient sitting, have pt turn head to relax a SCM; with your hand, displace the trachea to that side and palpate while she swallows
Posterior Approach
- index finger just below the cricoid
- displace trachea and palpate as the patient swallows
- DESCRIBE: size, symmetry, consistency
Auscultation
- over thyroid lobes for a BRUIT (thyrotoxicosis)
Special Tests
PEMBERTON’S TEST
- elevate, extend, rotate both arms for 3 min
- goiter → presyncope, SOB, cyanosis, plethora (compression of artery and veins)
Videos of Proper Examination
- Medical Examination of thyroid Gland
- Surgical Examination of a thyroid swelling
- Examination of clinical status of thyroid hormones
Signs and Symptoms of Thyrotoxicosis
General
- fatigue
- agitation, nervousness
- heat intolerance
GI
- ↓ weight
- diarrhoea
Dermatological
- warm and moist skin
- fine hair
- thyroid acropatchy (clubbing)
- onycholysis
- pretibial myxedema
Cardiovascular
- tachycardia
- ↑ pulse pressure, systolic outflow tract murmurs
- a fib
Neurological
- fine tremor - place piece of paper on patient's outstretched hand
- hyperreflexia
Insomnia, restlessness, irritability
Musculoskeletal
- proximal muscle weakness
Opthalmologic
- lid lag
- stare with ↓ blink
- widened palpebral fissures
Grave's Disease Opthalmopathy
- proptosis/exopthalmos - bulging eye
- chemosis - eye irritation
- EOM dysfunction (up gaze)
- corneal ulcerations
- optic nerve entrapment
rosenbach;s sign fine tremoreson closure eye lid
More OSCE Modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence
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