Thyroid Examination Wail Alamoudi. General examination Local examination

Thyroid Examination

Wail Alamoudi

•General examination

•Local examination

Local examination• Inspection• ( at rest , tongue , swallowing , raising both hands )

• Palpation• Percussion• Auscultation

•Tip the patients head back a bit•Inspect thyroid gland & scar•A visibly enlarged thyroid gland is called a goiter. •Note whether it is visible and symmetrical

Inspection at rest

Is This a Thyroid?

• Ask patient to stick tongue out while palpating:

• Ask patient to swallow water:

Should NOT move

Should move

Thyroglossal cyst

Inspection while raising hands

1. pemberton's sign ( retrosternal goiter )

development of facial flushing, distended neck and head superficial veins, inspiratory strider and elevation of the jugular venous pressure (JVP) upon raising of the patient's both arms above head

2. Proximal myopathy

ANATOMIC BONDARIES OF THYROID

• Cricoid cartilage• Suprasternal notch• Carotid arteries

palpation

ANATOMIC RELATIONSHIPS OF THE THYROID

Palpation

Palpation

• Palpate the thyroid gland from behind• Localize anatomic boundaries• Thyroid isthmus is often palpable• Thyroid lobes are barely or not palpable• The consistence is rubbery, similar to that of

sternomastoid muscle

Classical Clinical Examination

The following information could be obtainedývolume ýconsistencyýmobility of the thyroid glandýsurfaceýtemperatureýsensibility

Percussion

On the upper part of the manubrium looking for retrosternal goiter

Auscultation

Looking for bruit over each thyroid lobe

•General examination

•Local examination

General inspection

• body built• Eyes & Face• Hands• Arms & Legs

body built

• Thin • Obese

Face

1. malar flush2. Hair loss

1. Exophthalmos2. Lid retraction3. Lid lag4. Xanthelasma

Eyes

Hands

1. Sweaty hand2. Temperature3. Acropachy (clubbing)4. Onycholysis( plummer’s nails )5. Palmer erythema6. vitiligo7. Tremor 8. Pulse

Legs and Arms

• Proximal myopathy• Reflexes• Pretibial myxedema

Wail Alamoudi

0504649662

• Identify the cricoid cartilage with the fingers of both hands.

• Move downward two or three tracheal rings while palpating for the isthmus.

• Move laterally from the midline while palpating for the lobes of the thyroid.

• Note the size, symmetry, and position of the lobes, as well as the presence of any nodules. The normal gland is often not palpable.