Examination of the Thyroid Gland
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The Normal Patient: The thyroid gland should not be visible. The thyroid gland should be impalpable. Patient with a Goitre
Inspection of the Hands
Inspection of the Face
Palpation (is performed from behind)
Percussion: Over the manubrium and sternum: retrosternal goitre will cause dullness (malignant thyroid disease). Auscultation
Steve Goodyear MRCS(Ed)
of the Thyroid Gland
Patient is to be sat forward in bed, or sat in a chair away from the wall.
Neck exposed/shirt off.
Inspect from the front of the patient.
The Normal Patient:
The thyroid gland should not be visible.
The thyroid gland should be impalpable.
Patient with a Goitre:
Fullness on either side of the trachea below the cricoid cartilage.
, nodular organ either side of the trachea.
Any scars on the neck, suggestive of previous thyroid surgery?
Does the goitre appear regular or irregular?
the patient to swallow
, note movement.
Ask patient to stick-out tongue-?moves (Thyroglossal Cyst).
Inspection of the Hands:
Note the following:
Warmth/sweatiness. (Associated with Hyperthyroidism).
Wasting of intrinsic hand muscles. (Associated with Hyperthyroidism).
Peripheral tremor-rest a piece of paper on the outstretched hand. (Associated with Hyperthyroidism).
Clubbing: seen in Graves Disease (severe hyper)-called “Thyroid Acropachy.”
Oncholysis (lifting of the nail off the nail bed)-seen in Graves disease.
Tendon xanthomas: can be seen in hypothyroidism.
Dry flaky skin: seen in hypothyroidism.
Test for carpal tunnel syndrome: can be seen in Hypothyroidism.
Pulse, taken at the radial artery:
Tachycardia can be seen in Hyperthyroidism.
AF is also seen in Hyperthyroidism.
Bounding Pulse: hyperthyroidism.
Bradycardia: seen in Hypothyroidism.
Inspection of the Face:
Eyelid retraction and lid-lag: test with eye movements: seen in Hyperthyroidism.
Opthalmoplegia, conjunctival oedema, chemosis and exopthalmos: seen in Graves' disease.
Hair loss & loss of lateral 1/3 eyebrow: seen in Hypothyroidism.
Palpation (is performed from behind):
Warn the patient about the procedure!
Palpation of the Thyroid Gland:
Note symmetry, texture and extent of the goitre.
, layer of origin and surrounding skin.
Ask the patient to sip water and swallow.
Palpation of the Carotids:
The carotid arteries may become encased in malignant thyroid disease.
Palpation of the Lymph Nodes:
Include the nodes of the posterior triangle, anterior triangle and supraclavicular fossae.
Over the manubrium and sternum: retrosternal goitre will cause dullness (malignant thyroid disease).
the thyroid for bruits
, BOTH LOBES! Can be seen in hyperthyroidism.
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Human head and neck